The paper deals with important macroeconomic issues of health care financing, which are important for overall stability and performance of Czech economy. These include fiscal space for health, the configuration of universal health care financing and possibilities of voluntary extensions to universally available care. The approach is compatible with the WHO and OECD approach to financing health care systems. The paper will depict areas that we should focus on to improve health system sustainability, without making significant compromises in availability and quality of care.