In the Czech Republic, you can now see a doctor for about $1.85. A day in the hospital can verge on $4. This is not cause for celebration.

For Czechs, who visit their doctors more often than anyone else in Europe, it has led to great 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.

In 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 modest fees at the start of the year, the prime minister himself was forced before the constitutional court in Brno to testify as the court weighs overturning them. It is scheduled to rule on 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, there is a sense of betrayal, because the state long 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, new wealth for some — and their rising expectations for top-notch care — 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 widow who is a retired statistician. 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 and utilities. “I don’t buy anything else,” she said.

For healthy people with jobs, the fees are quite literally pocket change, usually paid with the same 10 and 20 crown coins as streetcar tickets in Prague ($1 is worth around 16 crowns). Affluent Czechs will admit privately that they spend far more on veterinary care for their cats and dogs than for 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 — though the system is financed in part through payroll deductions — 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 J. 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.”

Under communism, health care was free, only up to a point. Bribery for better care was a common practice and can still be a problem, particularly in Hungary where it remains widespread.

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

Slovakia introduced modest payments for doctors’ visits and hospital stays in 2003. But, as would later happen in Hungary, the fees did not last. The left-wing 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, and formerly the principal adviser to the Slovakian minister of health.

The need for reform in the region, Mr. 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 Mr. Pazitny’s partners in Prague. But the members of the opposition would prefer that their former countrymen left them — and their health care system — alone.