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Health plan to be bitter pill

THE GOVERNMENT is trying to prescribe another cure for the troubled Slovak health care system.
A new draft bill tailored by the Health Ministry could close down a number of hospitals and reduce the number of hospital beds.
The bill on the minimum public network of health care providers determines a list of 42 emergency healthcare providers and 23 specialised national hospitals, and sets the minimum number of hospital beds at 29,170.

THE GOVERNMENT is trying to prescribe another cure for the troubled Slovak health care system.

A new draft bill tailored by the Health Ministry could close down a number of hospitals and reduce the number of hospital beds.

The bill on the minimum public network of health care providers determines a list of 42 emergency healthcare providers and 23 specialised national hospitals, and sets the minimum number of hospital beds at 29,170.

The health insurers would be obliged to cover the hospitals included in the list with their contracts. Those that are not included might face a rather uncertain future as they would depend on the goodwill of the insurers.

There are currently about 150 healthcare providers with hospital beds, 70 of which are full hospitals, according to a health care think-tank, Health Policy Institute. Slovakia has about 38,000 hospital beds and the regulation that's in effect now requires at least 32,000 beds.

"The ministry expects to save about Sk2.1 billion (€62.9 million)," Health Ministry spokeswoman Silvia Balázsiková told The Slovak Spectator.

The new regulation is proposed to take effect on September 15. The bill is currently undergoing an interdepartmental review, the ministry said.

The proposal would help make health care spending more effective, said Marek Brezničan, the spokesman of Spoločná Zdravotná Poisťovňa, the third-largest health insurer.

Tomáš Szalay, an analyst with the Health Policy Institute, said the bill's greatest and only strength is that the number of hospital beds which the health care insurers must cover with their contracts would be reduced.

"Advances in medical science and changes to the structure of diseases have redefined the needs in providing health care," Szalay said. "There are too many hospitals in Slovakia that are not fully used, which wastes health care resources."

The institute strongly objects to the fact that the ministry has compiled the list of hospitals that would be guaranteed contracts with health insurers, and also to the way the list was created.

"A centralised administrative approach towards creating the minimum network opens up room for lobby pressures and corruption," Szalay said. "The health insurers should select the hospitals to be included in the contracts based on the criteria of quality and effectiveness, and not the state administration officers - based on what, actually?"

It is not even clear what criteria were used when creating this list, Szalay said. Moreover, the ministry is asking some of the health care providers to build new departments even though the bill does not provide for their financing, he added.

The president of the Hospitals' Association of Slovakia, Marián Petko, said he appreciates that the regulation defines so-called specialised hospitals operating at a national level in a way it has not done before.

"However, according to our calculations, the maximum limit of 30 minutes for transportation to the nearest emergency hospital (required by the legislation) will not be met in several cases," Petko said.

Most of the hospitals that did not make it on the list would be at the mercy of health insurers. However, insurers refused to speculate how many of these hospitals would still get contracts.

"We are yet to negotiate new contracts valid from January 1, 2008, with health care providers," said Petra Balážová, spokeswoman of Všeobecná Zdravotná Poisťovňa, the largest insurer in Slovakia. "We will observe the valid legislation and assure accessible and quality health care for our policyholders in all the regions."

Brezničan of Spoločná Zdravotná Poisťovňa said his company would also sign contracts with healthcare providers outside of the minimum network defined in the regulation.

"Other than being part of the minimum network, criteria like accessibility of the health care, the quality of the health care, technical equipment, personnel, and effectiveness will be considered," he said.

The total debt of the health care sector reached more than Sk6.8 billion (€204.3 million) at the end of last year, the SITA newswire wrote.

Every post-communist government in Slovakia has tried to find a cure for the indebted sector. The discussion on the need to cut hospital beds has been going on for 15 years. However, closing down smaller hospitals has been too difficult a decision for politicians to make, according to Szalay.

"Politicians cannot make the cuts correctly because they are under pressure from local politicians, and lobbyists engaged in various relations," Szalay said. "While the idea of the cuts should be supported (by the government), at the end of the day it will still be done by the health insurers, not the ministry. As the Všeobecná Zdravotná Poisťovňa insurer is the largest on the market, the key to making the cuts is through this insurer."

The health minister of the Mikuláš Dzurinda government, Rudolf Zajac, tried a different tactic to reform the health system. He wanted to introduce two types of health insurance: public, which would be obligatory, and voluntary. The latter would have covered services that go beyond the scope of general insurance.

Hospitals and health insurers would have been transformed into joint stock companies where managers would be responsible for the financial situation of their institutions. Zajac also introduced various payments for healthcare services. Slovaks paid Sk20 (€0.60) for every visit to a doctor, and the same fee was charged for every drug prescription issued. Hospital fees were Sk50 (€1.50) a day.

However, the current government of Prime Minister Robert Fico, whose members have been highly critical of Zajac's reforms, killed the plans. The government abolished the payments for health care services and it recently submitted a proposal to stop the transformation of hospitals into joint stock companies.

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