IF NURSES in Slovakia were to turn to the courts to claim the salary increase that a recently passed law is supposed to guarantee them, almost all of them would win: this is the opinion of Slovakia’s ombudswoman, Jana Dubovcová, who was commenting on one of the thorniest issues in Slovakia’s turbulent health-care sector.
Though the law on higher minimum wages for nurses has been valid since April 1, some hospitals say they lack the funds to increase salaries and are instead trying to get nurses to sign new employment contracts in order to reclassify them as clerks or social workers.
However, talks between Health Minister Zuzana Zvolenská and Mária Lévyová, the president of the Chamber of Nurses and Midwives, suggest that a gradual increase in nurses’ wages based on resources available within the entire health-care system might be one way to break the deadlock, given that smaller hospitals, in particular, say they do not currently have enough money to cover pay hikes.
“No one questions either the legitimate claims or the amount [of the hike]; we are talking about how to fulfil this in the given time,” said Zvolenská, who said she would lay out specific proposals on April 27, as quoted by the SITA newswire.
Zvolenská said that she could now guarantee that in May nurses in state-run hospitals would receive their guaranteed minimum salaries, but added that those in private hospitals are beyond the reach of the ministry.
It is not yet clear how much money will be needed to raise the salaries of doctors and nurses, said Slovak Medical Chamber (SLK) chairman Milan Dragula, as quoted by SITA on April 23.
The law mandates that the minimum starting salary for a nurse or midwife, without practical experience, should be at least €640 a month and that this should increase over the following three years to reach €666 per month. A nurse’s minimum salary is then supposed to increase every three months until it reaches €928 after 33 years of work experience, the SITA newswire wrote.
But complications around the nurses’ salaries are only the tip of the iceberg threatening Slovakia's health-care sector.
The Association of Private Doctors (ASL) recently asked the Health Ministry to arrange an increase in their salaries similar to the raise secured by doctors working in state hospitals, the TASR newswire reported. Doctors at state-run hospitals received an average salary increase of €300 per month after a mass protest last December.
According to ASL president Ladislav Pásztor, private doctors want to have a basic monthly salary of €1,600, which would require another €118 million being allocated to the health-care system each year. Pásztor said that private doctors do not challenge the right of nurses to higher salaries but that they believe they must be paid at least 2.2-times the salaries of nurses, TASR reported.
There are around 1,100 private paediatricians, 2,200 private general practitioners and around 2,000 private specialists in Slovakia, Pásztor said. He did not indicate what kinds of protests, if any, the association might engage in.
The difficult patient
“Slovakia’s health care is very ill,” Dragula said. “It is on the ground ... we are seeking ways to get it back on its feet.”
According to Dragula, a concession made by both parties might help to resolve the situation.
Slovak Hospitals Association President Marián Petko suggested that even if Zvolenská’s proposals do work, the existing problems are of a long-term nature.
“All the measures that are currently being prepared are aimed at staving off an impending collapse, but let’s wait a couple of days and see how real it will be,” Petko said, as quoted by the TASR newswire.
Zvolenská offered a glimpse of her proposals during a meeting with President Ivan Gašparovič.
“I am offering systemic solutions; other solutions would be a very wrong way,” Zvolenská said, adding that any proposals should be submitted by ministers only after financial coverage is secured for them.
After talking to Zvolenská and other representatives of the sector on April 23, Gašparovič said that the number of hospitals should certainly be reduced and that in future the density of health-care institutions and hospital beds will have to be addressed since the country has more capacity than it actually needs.
He added that drugs policies should also be stabilised while the Health Care Supervision Authority should start taking adequate action, especially towards health insurers, SITA reported.
Gašparovič said he is convinced that the health-care sector would not collapse since “the state and the government are here to consolidate these conditions”.
However, Petko said that if the state does not help smaller hospitals they might start going out of business in June. He said that although the hospitals are negotiating with the health insurers about an increase in payments, without the help of the state they will be unable to finance higher salaries and will have to start firing staff.
Changes for health insurers
Zvolenská has already suggested that there might be some changes in the operation of public health insurers.
The introduction of the so-called parameter of sickness for the redistribution of money between health insurers could be one tool used to help to solve the lack of money to raise the salaries of nurses and hospital doctors, Zvolenská suggested on April 22 during a political talk show on private broadcaster TV Markíza. She suggested that people who are more frequently sick are more likely to be insured with the state-run Všeobecná Zdravotná Poisťovňa (VšZP).
Thus, with the parameter of sickness rates, VšZP could have a larger package of funds and thus pump more money into the system of health-care institutions.
In a different political talk show, broadcast by the TA3 news television on April 22, Zvolenská said that health insurance should not be about making profits, so it would be appropriate to have only one health insurer. There are currently two privately-owned public health insurance companies in Slovakia, in addition to VšZP: Dôvera and Union. Zvolenská promised that an eventual draft to restrict health insurers’ scope to make profits will be presented only if it is in line with the constitution and international legislation, TASR wrote.
