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MINISTRY INSISTS PREPARED CHANGES ARE "RESPONSE TO DEMAND", NOT LEGALISATION OF GRAFT

Health Ministry wants two-tier system

MONEY may soon enable wealthier patients to get health services faster than regular patients.
In what observers have dubbed the legalisation of bribes in the health care system, the Slovak Health Ministry is planning to enable hospitals to collect extra payments if patients wish to be treated by a particular specialist. Wealthier patients could also pay to avoid waiting months for surgery.
It is estimated that Sk10 billion to Sk12 billion (€239 million to €287 million) of black money in white envelopes makes it into the pockets of Slovak doctors, and the Health Ministry admits that bribery is a problem in the system.

MONEY may soon enable wealthier patients to get health services faster than regular patients.

In what observers have dubbed the legalisation of bribes in the health care system, the Slovak Health Ministry is planning to enable hospitals to collect extra payments if patients wish to be treated by a particular specialist. Wealthier patients could also pay to avoid waiting months for surgery.

It is estimated that Sk10 billion to Sk12 billion (€239 million to €287 million) of black money in white envelopes makes it into the pockets of Slovak doctors, and the Health Ministry admits that bribery is a problem in the system.

The ministry believes that patients who have the money and want to receive special treatment should pay extra for the service.

But Health Ministry spokesman Tomáš Szalay denied that this was "legalisation of bribes". He added that planned changes to rules on health insurance and health insurers were merely "a matter of supply and demand".

"Some doctors are extremely popular and have good reputations as experts in their fields. But for logical reasons these doctors cannot treat all patients, and if there is a patient who wants to be treated or consulted specifically by the best doctor on staff, he can pay some extra money to make sure that happens," Szalay told reporters.

The proposal met with mixed reactions from several people The Slovak Spectator spoke to on August 11. While it seemed that most people thought the measure would discriminate against poorer patients, there were some who would welcome the changes.

One businessman, 37, who refused to be named, said: "Those who have money pay the bribes anyway, whether it is legal or not. We all know it is happening. If these payments are made transparent, at least the hospitals will get some extra funds to work with, rather than slipping the bribes into individual doctors' pockets."

But former teacher Elena Kováčiková, 62, said she did not approve of the measure.

"What if I can't pay any extra money? Will I get a bad doctor then? Don't we all pay health insurance that should secure quality health care for everyone?" Kováciková said.

But Szalay insisted that if the new system is put in place, it will not have drawbacks for those patients who cannot afford the extra payments.

"Patients will not be disadvantaged. Quality health care is guaranteed by the state to all patients. To make sure all patients receive the same quality health care we will also create an office that will supervise this in hospitals."

According to Szalay, although the system should enable wealthier patients to undergo surgery earlier by skipping waiting lists, this would only happen when other patients were not endangered.

"This will not be possible with life-saving operations nor any acute cases. But in planned, non-acute operations there are often long waiting lists and some patients may wait for months to be operated on.

"In these lists there are poor and rich patients alike. And if the rich patient wants to pay [in order to skip the waiting list] and the hospital's capacity allows it, then why not let him pay?"

The head of Zvolen hospital, Vojtech Žilinčan, welcomed the ministry's plans, arguing that extra resources could help hospitals to improve their financial situation.

"We need every extra crown. If this is introduced as an above-standard service, I am in favour of it," Žilinčan said.

The Slovak health care system is heavily indebted and it is also infamous for its corruption. It is believed that informal rates exist in almost every hospital for specific operations or services.

Various surveys have suggested that many Slovaks often paid bribes without even being asked for them.

It is also very rare for bribery cases in a hospital to be reported to the authorities.

Žilinčan, for example, said that in the four years that he has led the Zvolen hospital, he has never received an official complaint from patients regarding alleged corruption.

"I know that bribery in health care is a serious problem on a national scale but when there is no official complaint there is no impulse to address particular cases," Žilinčan said.

It is believed that patients bribe physicians because they want to make sure they receive proper attention from doctors. Medical staff in Slovakia are also relatively poorly paid especially when compared to their western counterparts.

According to Szalay, even the best Slovak neurologists earn as little as Sk24,000 (€570) per month. The new system would enable hospitals to start paying their doctors on a competitive basis, he added.

"When hospitals collect money from patients who want to be treated by specific doctors, they can give the latter more competitive wages, or invest some money into better services," Szalay said.

The Health Ministry has given no indication as to when the proposed changes would be brought before parliament.

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