Encouraging preventive check-ups

SLOVAKIA is among the countries with a health-care system that offers free preventive medical check-ups. Both health insurers and physicians perceive regular check-ups as a valuable tool for detecting diseases or other medical conditions at an early stage or even as a way to prevent the occurrence of some diseases and thus an important step in improving the overall health of the population. In spite of this many Slovaks do not take the opportunity to have regular check-ups, even when they are available for free. The good news is that the trend is moving at least slightly up.

“Preventive checks are fully covered by public health insurance and are focused on early diagnosis of serious diseases such as oncologic diseases,” Petra Balážová, the spokesperson of Všeobecná Zdravotná Poisťovňa (VšZP), the biggest health insurer in Slovakia told The Slovak Spectator.

Darina Sedláková, the head of the country office of the World Health Organization (WHO) in Slovakia, sees the situation in Slovakia as unsatisfactory. Even though interest in having preventive checks done by general practitioners has increased, certain age groups still do not take part, the TASR newswire wrote, citing Sedláková who said these are particularly people between ages 20 and 40 who believe they are in good health and have no need for such exams. The situation has improved in certain areas over the past two or three years thanks to extensive campaigns focused on breast cancer, cervical cancer and colorectal cancer. According to Sedláková, there is a need for a proactive attitude regarding health checks not only on the part of the state but also by health insurers who should encourage their clients to have periodic check-ups.

“Management of a patient who suffers from an early stage of a disease is always easier than when he or she arrives with a developed stage of the disease,” Sedláková said, as cited by TASR.

In Slovakia, preventive check-ups are covered under public health insurance to a defined extent and time period. For example, an adult is entitled to a preventive check-up at his or her general practitioner once every two years and a woman can have a preventive exam with her gynaecologist once per year. Annual free preventive dental check-ups are also covered and if someone does not have the annual dental check the cost of treatment for tooth decay must be entirely covered by the patient during the next year.

“In general it can be said that use of preventive checks has been increasing and that is a positive development,” Zuzana Horníková, the spokesperson of Dôvera, the second biggest health insurance company in Slovakia told The Slovak Spectator. “But there still exist a relatively high share of insured persons who continue to underestimate the value of prevention, even though they are entitled to it from public health insurance.”

At Dôvera, the most ‘popular’ preventive checks include check-ups for children by paediatricians, followed by dental exams and gynaecological exams, according to Horníková.

The health insurer Union has seen only a small change in the visit rate for preventive check-ups.

“The general visit rate for preventive checks by those we insure in 2008 was 34 percent,” Judita Smatanová, Union spokesperson told The Slovak Spectator. “In 2009 this rate increased to 35.2 percent. Preventive checks of children are the most popular.”

During the first nine months of 2009 those who are insured by VšZP utilised the opportunity to have dental exams the most, according to Balážová.

“The number of preventive checks increased at urologists, dentists, gynaecologists and general practitioners over the first three quarters of 2009,” she said. “We registered a moderate drop at paediatricians.”

Urological checks top the ranking of the least popular preventive checks at all three health insurers. This check-up is available to each man over age 50 years once every three years to detect early stages of prostate cancer. Union reported that the visit rate was below 1 percent in 2008 and had increased to only 1.2 percent in 2009, according to Smatanová.

“Men in general do not like visiting doctors,” said Horníková, adding that examinations linked with urological problems in general are not among those that are either pleasant or comfortable.

Check-ups by general practitioners are also very much neglected, according to Smatanová. The visit rate among those insured by Union was only 13 percent in 2008, with a small increase to 14.3 percent in 2009.

“The reasons behind the low visit rates for preventive checks can be various,” said Smatanová. “One reason can be that until a patient feels really bad, he or she puts off visiting a doctor. This reduces the chance for early detection of a disease or finding the disease in an early stage and this then lowers the possibility of treating the disease.”

The insurers are trying to raise more interest in preventive check-ups by educating people through media, leaflets, as well as through their websites. Union offers a free service which reminds their clients about the regular checks they should have. VšZP allocates over €26.7 million annually to support prevention efforts.

Because health insurance companies perceive check-ups as one of the most effective ways to uncover serious or possibly fatal diseases they are investing into such preventive efforts over and above the framework provided by public health insurance.

“Since currently cervical cancer and colorectal cancer rank among the most frequent oncologic diseases, VšZP pays for examinations which can uncover these diseases early,” said Balážová, adding that VšZP covers annual examinations helping to detect these diseases within its above-standard preventive care. VšZP also provides free flu vaccination and partly covers vaccination against hepatitis B.

Dôvera provides upper-standard prevention in three packages, the first of which focuses on vaccination. The other two packages are designed for women or men and focus on the diseases and preventive measures most appropriate for each gender.

Union also provides free vaccination against the seasonal flu and partly covers vaccination against the human papilloma virus and encephalitis. It also offers free examinations leading to detection of cervical cancer, colorectal cancer and other diseases beyond the compulsory insurance scheme.

To raise awareness of serious diseases and the importance of early detection and treatment, the health insurers, along with state organisations and NGOs, hold various public campaigns. Union became a partner in campaigns supporting prevention of breast cancer and cervical cancer as well as vaccination against the human papilloma virus (HPV) which can cause cervical cancer. Recently there was also a campaign across Slovakia focused on prevention and detection of early stages of colorectal cancer.