The article deals with changes in the concepts of health care that have occurred since 1989 in the Czech health system. It clarifies the different stages of this development and their socio-economic importance, at the same time mentioning the factors that have significantly influenced the development. It discusses the possibilities of optimal configuration in the future and the characteristics of individual models, preferring synergic effects between the universal and voluntary part of the system and mentioning the mechanisms in the area of private expenditure that can strengthen these effects. It also justifies why reducing universally available care under a socially acceptable rate or providing it through the purchase of insurance plans on the market is not an appropriate and promising solution for Czech conditions. Ethical objections to the supply and availability of above standard care can be neutralized by robust design of universally available and cost-effective healthcare. Above standard optional care has in most of the medical branches significant potential to increase quality, utility and comfort for clients, but medical and managerial efforts are required to provide it.