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FOREIGN AFFAIRS

Health care: Ounces vs. pounds

If there were any justice in the world, a steady diet of fried cheese and draft beer should be enough to ensure constant rude health. Nevertheless, foreigners living in Slovakia do occasionally get sick (usually because of an imbalance between the beer and cheese). Since being sick in a foreign country is twice as miserable as falling ill in familiar surroundings, it pays to know a few things about visiting the doctor before your throat is swollen shut.
The first thing to know is that doctors here know as much as doctors anywhere, and that unless you have a really obscure disease, you're wasting your time going to Austria for medical care at trouncing expense. Buy Slovak.
The second thing you should bear in mind is that the Slovak health care system is seriously short of money, and you're not going to see many frills in your visit to the doctor. But if you're hung up on frills, you're probably not all that sick.

If there were any justice in the world, a steady diet of fried cheese and draft beer should be enough to ensure constant rude health. Nevertheless, foreigners living in Slovakia do occasionally get sick (usually because of an imbalance between the beer and cheese). Since being sick in a foreign country is twice as miserable as falling ill in familiar surroundings, it pays to know a few things about visiting the doctor before your throat is swollen shut.

The first thing to know is that doctors here know as much as doctors anywhere, and that unless you have a really obscure disease, you're wasting your time going to Austria for medical care at trouncing expense. Buy Slovak.

The second thing you should bear in mind is that the Slovak health care system is seriously short of money, and you're not going to see many frills in your visit to the doctor. But if you're hung up on frills, you're probably not all that sick.

Thirdly, as a foreigner you're probably going to get the best treatment going, as Slovaks still feel bound by an old world hospitality which decrees that the stranger gets the sirloin while the locals eat rump roast. Thus, while it's normal for patients to take 'gifts' to the doctor, to come equipped with medical insurance, to queue patiently to be seen and to be obsessively polite and respectful, foreigners usually get away without being, doing or having any of these things. That won't happen in Austria.

Medical insurance

As a foreigner, you've got three options here. If you're a tourist, you will probably already have coverage from a foreign insurer, but you can buy medical insurance from the Slovak private firm Vzájomná životná poisťovňa (VŽP - Mutual Life Insurance). Ten days' coverage for emergency services for kids up to 14 starts at 660 crowns ($13.75).

If you are staying longer for certain reasons (i.e. you are a member of staff at an embassy, a family member of a foreign person working in Slovakia, a foreign student paying full fees) you can get coverage only at VŽP. Rates range from 890 Slovak crowns ($18.54) a month for a child up to the age of 14, up to 1,620 crowns ($33.75) for a woman between the age of 30 and 44 who is not pregnant, and presumably more for cancer-ridden, pregnant, hypochondriac 60 year-olds who smoke three packs of Camels a day. These sums cover all medical care, and vary according to age, health and how long you want to be insured for. You don't have to get coverage, and if you never get sick or have accidents this may look like a good plan, but if you once do have to visit a hospital or buy drugs at full expense, the cost advantage will be wiped out.

If, finally, you are a foreign business person or an employee of a Slovak firm, you are required to be insured. On the other hand, you have your choice of which firm you want to sign with (there are five state medical insurers in the country). You pay 4% of your salary towards health insurance (up to a maximum of 1,280 crowns a month) while your employer pays 10% (to a maximum of 3,200 crowns a month).

If you are working illegally in Slovakia, you're in a somewhat sticky position. You can't get health insurance except from VŽP (and even then only by pretending to be a tourist), but if you eventually do get a green card, you will have to repay to your state insurer all monthly premiums for the period you were working but didn't have health insurance.

Visiting the doctor

1. The Slovak health care system is divided into 'first contact' doctors and specialists. These first contact physicians, which in other countries may be known as general practitioners, are able to diagnose or cure an amazingly narrow range of ailments. If your foot hurts, your back aches or your eye is infected, you'll be sent to a specialist at a clinic or hospital. One of the reasons that they are so lethargic may be the health sector funding system, which gives doctors a set amount per patient. This system obviously does not encourage doctors to provide superior care, for which they receive no extra, and may even discourage them from offering normal care (since they receive a set amount per month, the more money they spend on care, the lower their net income).

2. Doctors' offices have no receptionists, in the western sense of the term, and it is thus not possible to make appointments. What you have to do is show up, like everyone else, at 7 a.m. and sit around in a fetid waiting room until your turn arrives. Expect people to try and jump the line. Bring a book.

3. Doctors are not accustomed to being challenged or questioned closely, nor are they accustomed to disclosing information. Be prepared to demand details of your illness, and don't be put off by a cold response.

4. Bribes are common, everyday things in the health sector, and may involve anything from a packet of coffee to several months' wages. However, they are far less necessary than people think. Don't be wheedled into giving one by your Slovak acquaintances or relatives, who can't imagine not giving the doctor a 'present'. The practice is a tedious one, and could immediately be stamped out if people simply refused to pay for care they are already paying for.

In general, if you spurn popular advice regarding bribes, demand proper service from doctors, cultivate patience with the peculiarities of the system here and don't expect to be coddled, you have access in Slovakia to one of the cheapest and most professional health services in the world.

Foreign Affairs is a bi-weekly column on questions of interest to expats. Next column on stands April 9 (Vol. 7 No. 14):Finding accommodation.

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