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Doctor's salary increase masks other problems

The long running dispute between doctors and the Ministry of Health over a salary increase appeared to have ended when the government and the medical community agreed on a 35 percent pay raise that took effect April 1. However, though an agreement was reached, the compromise masked what everyone in the health care industry knows: because Slovak hospitals and other health care institutions are financially in dire straits, those receiving a pay increase doubt that the government will make good on its pledge.
The project, called "the extensive strategy for doctors and others, working in health care for 1996-98," mainly focuses on a timetable for a salary increase.

The long running dispute between doctors and the Ministry of Health over a salary increase appeared to have ended when the government and the medical community agreed on a 35 percent pay raise that took effect April 1.

However, though an agreement was reached, the compromise masked what everyone in the health care industry knows: because Slovak hospitals and other health care institutions are financially in dire straits, those receiving a pay increase doubt that the government will make good on its pledge.

The project, called "the extensive strategy for doctors and others, working in health care for 1996-98," mainly focuses on a timetable for a salary increase.

The program incorporated a three-stage pay hike. The first increase of 20 percent webt into effect last July 1. The second stage was April's 35 percent raise, and the last one is a 45 percent rise scheduled for the end of this year. The increases include a seven percent allowance for yearly inflation.

But the government hasn't endorsed the proposal yet. According to the Ministry of Health's spokeswoman though, it doesn't matter whether the cabinet has officially accepted the accord, because it already went into effect.

Dr. Tibor Barta, a doctor at the nose-ear-throat department at Zochova Hospital in Bratislava and also president of the Association of Doctor's Trade Unions, disagreed.

"It is important to have that decree in April endorsed by the government," Barta said. "Otherwise there will be added tension in society, and I wouldn't eliminate that the trade unions would take certain steps if they don't accept it."

Another big problem is financing the project. The government has so far been unwilling to allocate extra spending from the budget, so the measure is supposed to be financed by insurance funds.

"Financing all the salaries by insurance funds is nonsense," Barta said. "Currently all the insurance companies have big money problems," said Dr. Magdalena Laufíková, a legal specialist for the Trade Union of Workers in the state Health and Social Services - an older version of Barta's 3,500 member union.

"And it is impossible for them to give more to hospitals," Laufíková continued. "So it means that the same amount of money which the hospitals receive from funds today will be divided into more areas. The real consequence will be less money for drugs and services for patients."

Doctors are aware of the problem. "My colleagues and I know about this issue from the media," said 26-year-old gynecologist Jozef Záhumensky.

"It would be fantastic to have a bigger salary," Záhumensky said. "My current salary is 6,590 Sk (35 Sk/hour). A plumber gets at least 100 Sk/hour, which means I have to work for three hours to pay for one-hour of work by a plumber."

Slovak hospitals and other healthcare institutions owe millions of crowns to delivery and supply companies (for drugs, electricity, water, etc.), but the insurance companies owe them even more.

Barta thinks the problem of paying among three parties (supply-hospital-insurance) is practically unsolvable under the current conditions. "It's like a vicious circle," Barta said. "Hospitals don't pay delivery companies, because they don't have money. The reason they don't have money is because insurance companies owe them money. The state, which is supposed to pay insurance for people at the lower end of the social scale doesn't pay enough and not in time." "Actually it is a state, who is the biggest debtor in this circle," Laufíková added.

Poss ADDS

"To make more and to feed my family I have to do some extra work during the weekend. So I think, it is essential to increase our salaries. But on the other hand, I realize it will reflect on the standards of services for patients," said Záhumensky adding that his colleagues think the same.

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