WHILE in the past health care in Slovakia was free of charge, at least officially, along with compulsory health insurance Slovaks pay some fees when visiting physicians or specialists in their offices. The Health Ministry sees some of these fees as unreasonable and has prepared new legislation setting a framework for fees general practitioners and specialists can charge patients. Meanwhile, physicians argue that they require payments for services not covered by health insurance companies and to compensate for stagnating payments from the public health insurance scheme.

The Health Ministry introduced a draft legislation it prepared in cooperation with doctors and patients’ organisations in early June, which could become effective this autumn. Based on the draft, doctors will prepare their price lists and regional governments (VÚCs) will green light them and check whether the doctors are sticking to them. The VÚCs will only be allowed to approve or reject the fees for individual activities, while the doctors themselves will decide how high these fees will be. The ministry started working on the new legislation about 18 months ago.

The current system of fees does not specify clearly enough what a patient should or should not pay for in a doctor’s office, officials say. In practice, the new legislation will enable doctors to collect fees for their services and work not covered by health insurance.

“Doctors will be allowed to collect fees for services linked with the provision of health care and for activities when treating diseases which are not covered from the public health insurance,” said Kristína Nedielková, general director of the Health Ministry’s legal section, as cited by the TASR newswire, adding that doctors must not condition provision of treatment covered from public health insurance with any payment from the patient.

For the time being, doctors require €10-€15 fees for elaborating a medical report for spa treatments covered by a health insurer, and for a document about a client’s health condition for getting a driver’s or gun licence; and €5-€10 for arranging a priority appointment for a specific date and time, for a note confirming for the employer that an employee had a doctor’s appointment, for prescribing medicine; and fees for providing air conditioning or WI-FI in the waiting room. Doctors are not required to keep records on the collection of these fees.

Among the most criticised fees is one for scheduling a priority appointment. In Slovakia the system in most offices of general practitioners as well as many specialists is that patients come to the waiting room and wait their turn. Those, who want an appointment for a specific date and time have to book ahead and pay. The ministry wants to limit this fee and proposes that the doctor can ask for it only when the appointment is made within five days from when the patient asks for it. It argues that only this constitutes a priority assignment, while the ordinary one is covered by public insurance.

View of doctors

Doctors explain that they collect fees from patients to compensate for stagnating payments from health insurers and to cover services they provide, but health insurers do not pay them.

Doctor Jozef Klucho agrees that it is necessary to bring order to the fees. But he points out that health insurers often do not pay doctors for administrative activities as they are supposed to, for example, for preparing medical reports for patients applying for covered spa treatments. When insurers do not pay for these activities, he sees no reason why doctors should not require this payment from patients.

“It is absurd to require doctors to do for free what insurers do not pay them for,” Klucho wrote in a piece for the Sme daily.

Internist Juraj Mistrík pointed out for the Pravda daily that the value of the so-called points on which individual activities and treatments provided by doctors are calculated and paid for by health insurance, has not increased since 2008, while the costs to run a doctor’s office have been increasing.

“We are forced to survive somehow,” said Mistrík as cited by Pravda. “I have an agreement with a patient that he or she will pay me some fee. I collect from a patient who comes one time per six months €10 for arranging an appointment.”

Tomáš Szalay, analyst from the Health Policy Institute, recalls that after the compulsory payment introduced by Health Minister Peter Zajac of about €0.67 per visit of a doctor was cancelled in 2006, doctors have not been compensated for this decline in their incomes. Thus doctors looked for ways to compensate for lost income and they were very creative. He expects that after the new framework is introduced, doctors will be creative again.

While the new legislation will touch upon only fees required by doctors, doctors will be able to ask patients for donor payments.