In the Czech Republic, a patient can now see a doctor for about $1.85. This is not cause for celebration.

For Czechs, who visit their doctors more often than anyone in Europe, it has led to outrage. In fact, the idea of charging anything at all for health care can generate significant controversy, not to mention abrupt about-faces in policy, here and in other Central European countries.

The theory is to cut waste and abuse from the health systems to strengthen and modernize them. But the backlash can be powerful.

n Hungary, health care fees were resoundingly defeated in a nationwide referendum in March, which resulted in the firing of the health minister. Here in the Czech Republic, which began imposing the fees at the start of the year, the prime minister himself was dragged before the constitutional court in Brno to testify as the court weighs overturning them. It is scheduled to rule Wednesday.

Countries rich and poor struggle with how best to provide affordable health care to their citizens without breaking the bank. In places like the Czech Republic, the difficulty is sharpened by the clash between the rapidly rising expectations for the latest and best treatments and the long-ingrained habits of Communist-era unlimited, free health care on demand.

There is a sense of betrayal, because the state once took care of them, but also a justified fear for those left behind in the recent years of growth and change. Even in Prague, known as the golden city, newfound wealth for some has meant only higher prices for those trapped with low salaries or fixed pensions.

“I have to save so I have money for food,” said Kveta Lachoutova, 78, a retired statistician and widow.

In an interview in the waiting room at her doctor’s office here, she said that she was trying to live on a monthly pension of about $600, while spending close to $400 on rent

For healthy people with jobs, the fees are literally pocket change, usually paid with the same 10 and 20 koruny coins as streetcar tickets in Prague ($1 is worth about 16 koruny). Affluent Czechs will acknowledge privately that they spend far more on veterinary care for their cats and dogs than their own medical care, even with co-payments for some medications.

But many Czechs see it as a matter of principle that health care should be free, along with a strong sense of solidarity for the poor.

“The only analogy I can think of in our political culture is primary schools,” said Marc Roberts, a professor of political economy at the Harvard School of Public Health who has worked in Central Europe. “Most people in the United States believe that primary education should be free and open to all and that it shouldn’t be subject to market principles.”

The region has been a living laboratory of health care reform in recent years. The effort has been spearheaded by free-market advocates from booming Slovakia, which has a flat tax and scorching economic growth - more than 10 percent last year.

Slovakia introduced modest payments for doctor visits and hospital stays in 2003. But, as would later happen in Hungary, the fees did not last. The leftist government that came to power in 2006 rolled them back later that year, within just a few months of taking office.

“What we want to achieve in the health system is a higher individual responsibility, making the consumers more responsible for what they consume,” said Peter Pazitny, executive director and one of the founding partners at the Health Policy Institute in Bratislava, Slovakia, and formerly the principal advisor to the Slovakian minister of health.

The need for a health care overhaul in the region, Pazitny said, is obvious. Statistics from the Organization for Economic Cooperation and Development show that the Czech, Slovak and Hungarian health care systems rank at or near the bottom of all member countries in life expectancy, as well as mortality rates for strokes, heart disease and cancer.

The Czech government was receptive to the Health Policy Institute’s input, and even employs another of Pazitny’s partners in Prague. But the opposition would prefer that their former countrymen left them - and their health care system - alone.

“I would understand if these Slovak boys would do it as a paper for their seminar at university, but here they are introducing it into real life,” Michal Hasek, leader of the Social Democratic caucus, the largest opposition party in Parliament, said in an interview in his office.

The Czech Constitution says that “citizens have on the basis of public insurance the right to free medical care and free medical aids under the conditions defined by the law.” The new payments were not only unconstitutional, according to Hasek, but causing real pain in some segments of the population. Opponents and the local tabloid press have made premature babies in incubators, whose parents must pay the hospital fees, into symbols of the new system.