When Finance Minister Brigita Schmögnerová introduced her proposed state budget for the year 2000 in the government two weeks ago, Health Minister Tibor Šagát was one of the first to protest. And no wonder - the 40 billion crowns ($1 billion) that Schmögnerová has earmarked for the Ministry of Health is three billion crowns less, in nominal terms, than it received this year, and 13 billion less than Šagát has requested for next year. The shortfall, Šagát said, will bring the healthcare sector to its knees.
Health experts, from MP's to Health Ministry officials and doctors, agree that the funding cut for 2000 will destroy even the few quality healthcare services that have been preserved in this collapsing sector.
What is worse, experts add, is that the cuts arrive just as the Health Ministry is coming to the most crucial phase of a reform programme launched in November, 1998 to rein in the sector's growing deficit and balance the expenditures and revenues of health care providers.
The reforms aim, among other things, to reduce the number of beds in Slovak hospitals by 3,500 by the year 2002, and instead to emphasize the virtue of home treatment. Health Ministry officials hope that by restricting beds they will cut down on the amount of time that people spend in hospitals, and thus reduce the financial burden on the state.
More serious reforms - reducing the state share on health care expenditures from the current 97% to around 75%, with the difference made up by patient payments - will require amendments to the constitution, and are not scheduled to take place until 2001-2002.
But with only 40 billion crowns in the year 2000, ministry officials say, the reforms will have to abandoned. "This figure [40 billion crowns] will be enough for the sector to survive, nothing more," said Rudolf Štefanovič, director of the health care section at the Health Ministry.
Štefanovič said it was a shame that the reforms would be halted, because they had already begun to generate savings. "During the first year of this reform programme, we managed to cut consumption by a surprising 300-400 million crowns [$7.5-$10 million] per month in the sector."
According to Štefanovič, the figure proposed by Schmögnerová would have to be increased by 4.5 billion crowns to ensure even the basic survival of the health sector , assuming no growth in salaries and a decline in its debt burden. "If we only get 40 billion crowns, our accounts will be frozen, and as a chain reaction our current debt of 11.8 billion Slovak crowns will grow," Štefanovič said.
For the next phase of the transformation process to be implemented, the Ministry of Health has calculated that it will need an extra 9 billion crowns over the proposed budget figure.
The share of health care expenditures on GDP in Slovakia is one of the lowest in Europe. After hitting a peak of 6.6% in 1996, a prosperous year for the country in general, it declined to 5.9% in 1999, and according to the Finance Ministry proposal will fall to 4.9% in the year 2000. That figure would make Slovakia the most tight-fisted health care provider in Europe, where countries spend an average of 7% to 9% of GDP on health care. And with its 11.9 crowns in accumulated debt, the Slovak health care sector can only envy Scandinavian countries like Norway, which has a 380 billion Slovak crown health sector surplus so far this year.
Roman Kováč, a gynaecologist by profession and chairman of the Parliamentary Health Committee, said Schmögnerova's proposal was "absolutely unacceptable." If the Finance Ministry could not be prevailed upon to increase the health budget, he said, "then somebody will have to go and explain to citizens that some health care services which have been free so far will now have to be paid for. At that moment, this health issue will become a tough political question."
Kovač said he was confident he could squeeze an extra five billion crowns out of the Finance Ministry. "We are prepared to invest 90 billion crowns into restructuring banks, and several billion crowns into rescuing[state bank] IRB every year," he said. "I know that economic issues are very important, but if a person should die because of lack of financial resources, that would be the worst catastrophe for this government."
Ladislav Petričko , the president of the Slovak Chamber of Doctors, said that before the parliamentary elections in 1998, doctors had hoped for real change in state leadership of the nation's hospitals. "They [doctors] are now losing patience, because when they don't have even the most basic equipment for doing their jobs, they begin to ask themselves the question, 'Why am I a doctor?'," Petričko said.
Petričko explained that Health Minister Šagát had achieved a great deal so far in bringing the health care sector deficit down from a record 13 billion crowns at the end of 1998. The minister's reforms were responsible for the drop, and were aimed at bringing the sector back to its 1995 state, when it was free of debt. "Now, if the health sector doesn't get money to continue with its reforms, the deficit will grow again," Petričko said.
The latest research shows that the Slovak government pays an annual $198 per citizen for health care. In the Czech Republic, the figure is $340, in Austria $1,300, and in the US $1,800. Kováč and Petričko agreed that given the political will and a more efficient economy, Slovakia could be far closer to these latter totals. "I just don't believe that there aren't funds to help increase money in the health sector," Petričko said.