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New fees launch health reform

PROVIDED the country's president signs a law recently passed by parliament, Slovaks will start paying fees ranging from 0.50 to 1.20 euro for various health services.
A rewritten health-services law passed on March 6 by the Slovak parliament introduces a number of payments, including Sk20 (0.50 euro) per doctor visit, Sk20 (0.50 euro) per drug prescription, Sk2 (0.04 euro) per kilometre travelled in an ambulance, and Sk50 (1.20 euro) per day spent in hospital.
Patients will continue to get some medication for free, but other drugs that used to be free will now have to be paid for.

PROVIDED the country's president signs a law recently passed by parliament, Slovaks will start paying fees ranging from 0.50 to 1.20 euro for various health services.

A rewritten health-services law passed on March 6 by the Slovak parliament introduces a number of payments, including Sk20 (0.50 euro) per doctor visit, Sk20 (0.50 euro) per drug prescription, Sk2 (0.04 euro) per kilometre travelled in an ambulance, and Sk50 (1.20 euro) per day spent in hospital.

Patients will continue to get some medication for free, but other drugs that used to be free will now have to be paid for.

The Health Ministry expects the fees to help slow down the spiralling health-sector debt, which at the end of 2002 reached Sk28 billion (670 million euro).

The law is the first in a series of legislative measures Health Minister Rudolf Zajac plans to adopt by 2004, in his effort to reform the country's ineffective health sector, whose debt is growing by Sk600 million (1.4 million euro) every month according to the Health Ministry.

"The law will increase payments by an average of Sk40-45 (1.1 euro) per patient per month. But mainly it will bring certainty that the health sector has moved in the right direction," Zajac said, after the law's passage.

However, opposition politicians appealed to President Rudolf Schuster not to sign what they said was an unconstitutional law that would "further decrease the already low level of Slovak health care," in the words of Karol Fajnor from the Slovak Communist Party.

In their constitution, all Slovaks are guaranteed free health care. Zajac said, however, that a team of expert lawyers advised him that his reforms were not in conflict with the constitution.

Ordinary Slovaks had mixed feeling about the introduction of fees.

Elena Baníková, a 35-year-old secretary from Bratislava, said: "Twenty crowns is not so much money, I don't have any problems with the fees."

Others said they were worried that the fees would be unbearable, particularly for those who are dependent on medication due to their illnesses.

"I have to see my doctor regularly so that he prescribes me pills for my heart and I also go to the optician because I need drops. Twenty crowns adds to another 20 crowns, and I end up paying hundreds extra when I also count the money I have to pay for medication," said retired resident of Bratislava Ján M.

The new law cuts down the number of groups of medicines in which at least one drug is available for free by nearly half, from 220 to 130, a move that would "further limit the availability of free medicine," according to the Slovak Association of Drug Producers.

The ministry, however, maintained that poor people and other disadvantaged groups would be granted exemption from the fees, and that life-saving drugs and a lot of medicine for common illnesses would continue to be paid for by the state.

Pregnant mothers, young children, regular blood donors, mentally and chronically ill patients, and other disadvantaged groups do not have to pay the fees under the new legislation.

Health ministry officials said they also wanted to stem what Zajac called "excessive" use of health-care services and drugs in the country.

"We want to cut down on the excessive consumption - eliminate drugs being thrown into waste containers, unnecessary stays in hospitals, unnecessary sick leaves. This needs to be done so that the money in health-care sector serves those whom it should serve: people who are really ill," Zajac said.

He said the average Slovak visited a doctor 15 times per year, while western Europeans visit their doctors an average of five times per year.

Slovakia is infamous for its excessive demand for drugs, with masses of prescribed but unused and expired drugs being returned every year to collecting centres in pharmacies. In 2001, nearly 38 metric tons of such medicine was collected, up from 20 tons in 1999 and 25 tons in 2000.

Opponents to the changes, however, warned that the fees could lead to a situation in which some patients will not be able to afford medication.

Ernestína Tóthová, spokeswoman for the Slovak Pharmacists Chamber, said: "We think this will be a hardship test for a number of patients, mainly for families with small children and for pensioners."

President Schuster has 15 days to decide whether he will support the bill or return it to parliament. The president's spokesman, Ján Füle, said Schuster has not yet made up his mind about the law.

Despite the objections to the law, Minister Zajac says he is determined to continue unpopular reforms in his sector, hoping Slovaks will soon see positive results of the changes.

His ministry has pledged to prepare a series of legislative measures, including a new law on health-insurance firms, a law on supervision of health-care services, and a general health-insurance law. It also plans to introduce a performance-related pay system in the health-care sector, to enable the best health-care personnel to earn the highest salaries.

"If parliament keeps its current courage through next year, we should [soon] see the first clear results [of the reforms], and in 2005 the health system could be working as well as it does in EU states," Zajac said.


What fees?

* Sk20 per visit to general practitioners and specialists. If a patient visits the same doctor twice on one day, he only pays one fee.
* Sk20 per emergency visit. Doctors keep the fee.
* Sk20 per drug prescription. One prescription may contain a maximum of three medicines. Of the fee, Sk15 goes to insurance firms and pharmacies keep Sk5.
* Sk50 for each day spent in hospital. The maximum number of days patients have to pay for is 21. Hospitals keep the fee.
* Sk2 per kilometre in an ambulance. Seriously disabled people pay Sk1 per kilometre. If more people are transported in an ambulance, they share the fee. Fees are not paid when a patient calls an ambulance in an emergency situation.
For the majority of the fees, exemptions apply to certain groups of patients, such as poor people, children under six years of age, regular blood donors, mentally disadvantaged patients, and people with serious disabilities.

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