Tibor Šagát, Health Minister
Given the current crisis in Slovakia's health care sector, Šagát has many hard choices ahead of him as Minister. The Slovak Spectator caught up with him in Parliament, and asked him how he planned to solve the sector's most pressing financial and structural problems.
The Slovak Spectator (TSS): The current deficit in the Slovak health care system is, according to forecasts, 10 billion Sk ($277 million). What will be your first steps to rein in this figure?
Tibor Šagát (TŠ): Right now, we are working on quantification of the deficit, but I'm sure the final figure will be above 10 billion Sk. We are preparing an amendment to the state budget, in which we will specify the amount of money we need and the specific ways in which it should be used. So, one of the first steps is to set the parameters of financial support. By November 12, we should have a proposal ready for changes in the financing of healthcare. We expect that part of the money will come from the state and the other part will be loans from commercial banks.
TSS: When the current government parties were in opposition, they criticised the non-transparent privatisation of healthcare institutions and pharmacies. What will you do to set things right?
TŠ: This is another problem that requires deep analysis, which takes some time. We need to see the contracts at the [state privatisation agency] National Property Fund (FNM), contracts that were not accessible to us [opposition MP's] during the previous government. Then we'll take stock of privatised institutions, evaluate their contributions to healthcare, and after that comment on the future of the privatisation process - that might be at the beginning of next year. We are happy that government didn't sell the institutions it intended to, because this will make it easier to reach decisions.
TSS: What legislative changes do you plan to make in healthcare?
TŠ: We have to correct two laws, one of which is the Law on Health Insurance and the other the Law on Treatment. We'd like to change them in the first half of 1999. The finances we want from the budget will depend on our taking certain transformation steps. If we submit them to Parliament, the fight for money might get really tough. Simply, economists are only willing to give us money if they can see that it will be used effectively. And that's important, because we can regulate the cash flow only through health insurance companies. But we don't want to abandon the theory of financing healthcare through insurance houses, even though people have begun to have their doubts about this method.
TSS: The General Healthcare Insurance House (VŠZP) is currently the only one which is accepted by all healthcare institutions and pharmacies. How do you want to balance the disparity between the finacially healthy VŠZP and other insolvent insurers?
TŠ: We want to fulfil our resolution about the equality of insurance houses. VŠZP will be used to pursue the state's healthcare policy, because it's a huge insurance house with approximately three million people insured [Slovakia's population is 5.3 million]. VŠZP will also be the one to make progress in our sector, since it has lots of information on people which hasn't been used at all. For such a quantity of personal medical data you need a central registrar, but despite my initiative in 1994 this body hasn't been created so far.
Another issue concerning health insurance houses is the conditions for creating a new insurance firm. Here, we want to make the rules more strict. We won't put that much stress on the number of insured people the firm recuits, but we will want to see what kind of know-how they have. Plus, we'll set the conditions for cancelling the license of insurance companies if needed, so that insured people find themselves suddenly without insurance. This will also be a part of the law on health insurance.
TSS: How do you want to solve the problem of politically-motivated nominations to the highest posts in the healthcare sector during the previous government?
TŠ: Back in 1994, we solved this question by holding a public job-search to fill the positions of all hospital directors who had been appointed to their posts without an application process open to the public. By the end of this week [November 2-8], we'd like to talk to professional organisations about our proposal for change. We want them to comment on it, and we want to reach an agreement together.
Basically, there are three categories of previous top healthcare managers. The first ones are those whose ineptitude was proven even during the previous government, and those people will have to leave. The second category comprises directors who were dismissed without being given a reason, and who were replaced by new people who were appointed without a due interview process. These latter will be dismissed, and we will offer the old directors their jobs back. The last category contains directors who won tenders a long time ago, but whose hospitals are having problems. We'll invite them to come in for interviews, and we'll examine their managerial skills. If they don't make the grade, we'll hold a public competition for their posts.