AVAILABLE drugs dwindle as pharmacies refuse to replenish their stocks.
In a nationally coordinated move, pharmacies on November 10 took the steps and said they would not back down until the estimated Sk7 billion (€170 million) debt that health insurance companies owe them is settled.
With many of Slovakia's pharmacies low on stock already, people who need drugs are at risk of not receiving their medicine from pharmacies. Some have already reported having to travel to nearby towns and cities to get their medication because their local shops were either closed or out of stock. Pharmacies in the southern Slovak town of Lučenec, meanwhile, reached a critical situation when they ran out of insulin for diabetes patients.
The move, initiated by the Slovak chamber of Pharmacists (SLeK), is designed to push the state and health insurance companies to pay the country's estimated 1,100 pharmacies their outstanding bills. Many pharmacies have not received payments since February and March, while a considerable share of debts that go back years have not been paid either.
In Slovakia, the sick usually get their prescribed drugs for only minor fees at pharmacies, which charge the costs to health insurance companies. Insurance firms are expected to pay for the individual patients' drugs out of their respective insurance accounts.
At the same time, pharmacies buy their stock from distribution firms and are therefore under pressure to pay the distributors. Many pharmacists took out loans from banks to cover the most urgent payments until money from health insurance firms arrived. But debts have accumulated, as have interest fees for belated payments.
Ján Valjan, SLeK's deputy chairman, said to The Slovak Spectator on November 11 that "of the Sk7 billion, our debts to suppliers make up about 86 percent".
Despite saying he understood the difficult situation of pharmacists, Health Minister Rudolf Zajac accused the pharmacies of "taking patients hostage" with their new strategy.
The Health Ministry has also initiated moves to withdraw licences from four pharmacies that, according to the ministry, have violated rules under the law on drugs and health utilities during the strike.
Private TV Markíza reported on November 11 that one woman from Nitra has sued one of the city's pharmacies, which refused to provide her with drugs for her husband, who suffers from cancer.
Recent pressure by the pharmacies is much discussed and this strike is widely seen as the strongest form of protest staged by the group so far.
Until now, pharmacies staged several strikes to signal their unhappiness with the growing unsettled debts, but these usually lasted a symbolic one hour or one day at the most.
Until now, no health minister has managed a systematic effort to eliminate the debt. Usually, at times when pharmacies put on the most pressure, a big chunk of money was released in one shot. The overall debt continued to grow and no systematic steps were taken to get rid of it.
Zajac is seen as the first Slovak health minister to initiate an effort to address the massive debt towards pharmacies, and for that purpose, the state joint-stock firm Veriteľ was founded.
Veriteľ receives money from the state and buys pharmacies' claims towards insurance firms. Veriteľ then settles the purchased claims with insurance firms individually. But many pharmacies refuse to use Veriteľ for elimination of their debts, dubbing the company non-transparent. They also say Veriteľ has too little money to settle all of their claims and that they want their interests from belated payments to be covered - not just the nominal owed sums.
Alexandra Novotná, spokeswoman for the Health Ministry, said to The Slovak Spectator that about Sk1 billion (€24.3 million) has so far been released to Veriteľ, adding, "sure, this is a fraction of the whole debt, but it's a start."
She also said that if pharmacies did not trust Veriteľ, they did not trust the cabinet, which founded the company.
"They are putting a knife to the neck of the [PM Mikuláš] Dzurinda cabinet over these debts, despite the fact that many of them were accumulated under previous cabinets," Novotná said.
In a recent TV interview, Zajac even suggested that pharmacies were exercising "undue pressure".
"We really do what we can. We are looking for money that we could release into the [debt elimination] system," Zajac said.
But pharmacists have rejected the claims that their reaction was inappropriate.
SLeK's Valjan, who owns a pharmacy in the eastern Slovak town of Spišská Nová Ves, said, "this is neither a protest nor a strike. This is an economic necessity."
"Pharmacists must behave like reasonable businessmen. We owe money to suppliers and we have to pay that to them. They accuse us of taking patients hostage, but we are the real hostages of the system," Valjan said.
The public is widely split on the pharmacy attitude. Many people who spoke to The Slovak Spectator supported pharmacies, but several others were angry that that they had to suffer for something that was not their fault.
"I wonder where the health insurance money deducted from my wage every month is put," said one man, 43, who wished not to be named.
According to František Valášek, head of the country's largest health insurer, VšZP, the administrative board of the company approved several measures to address the situation, releasing its reserves for an initial Sk174 million (€4.2 million) injection into the system.
Last week, the VšZP also agreed with Veriteľ on a non-interest loan worth Sk500 million (€12.15 million) to settle the debt, while Zajac pledged the insurer would soon receive another Sk600 million (€14.58 million).
In an interview with the Slovak TV news channel TA3, Valášek said that, by the end of the year, insurers would be able to pay the pharmacies all invoices dating back to the end of July this year.
It remains unclear what will happen between now and then, and whether the pharmacies will continue their protest. Valjan said SLeK wanted to meet with VšZP to discuss the problem next week.
18. Nov 2003 at 0:00 | Martina Pisárová