WILL citizens pay for most basic treatments?
The information that patients will soon have to pay for the treatment of minor injuries, for examinations in cases such as the flue, and for some dental procedures has evoked considerable unease in a society that already carries the burden of several austerity measures taken to heal the country's economy.
Apart from the problems of having an ageing population and skyrocketing costs for medical treatments, Slovakia is struggling with problems resulting from a far too generous healthcare scheme and a constitutional commitment to provide compulsory free health insurance, inherited from the communist regime.
Since communism's fall in 1989, each health minister has stressed the necessity of reforms, but only the attitude of the current centre-right ruling coalition has enabled Zajac to launch the badly needed revamping.
Though new treatment methods have found their way to Slovakia, the economy does not have the money to pay for them. The old system was designed to cover regular costs, but it is far from effective in covering the new treatments, which can be several times more expensive.
The problem of an ageing population has further added to the economic burden. While the life expectancy is increasing, the number of economically active people, who most contribute to the health insurance scheme, has been shrinking.
As a consequence, people are often unable to receive the necessary level of treatment; for example, information on the lack of drugs for cancer patients recently leaked to the public.
Minister Zajac started pressing hospital directors to behave more economically and cut costs. As of June 2003, people started paying Sk20 (€0.50) per doctor visit, drug prescription, or medical aid.
Hospitalized patients are charged Sk50 (€1.20) for accommodation and catering services for each day they spend at the hospital. The Health Minister has attacked the notion that "healthcare is free of charge."
Zajac argued that the point of these charges was not to raise money for the sector but to make people realize that even if healthcare is free of charge, it does not mean that "it costs nothing". In the four months since the introduction of the charges, the hospitals have collected over Sk80 million (€1.94 million) from patients.
Health insurance companies have reported a decrease in spending on drugs, but experts have attributed the decrease to the fact that the patients stocked up on drugs before the prescription charge became effective.
The introduction of charges has stirred criticism from the government's opposition: the opposition party Smer's leader, Robert Fico, has objected to the introduction of the fees at the Constitutional Court. He argues that the Slovak Constitution should secure free healthcare. The court has not brought any verdict on the case yet. Healthcare experts have warned that the introduction of the charges is only a facelift that will bring no systemic improvements into the healthcare scheme.
Minister Zajac has already submitted to interdepartmental review two draft bills of a sextet of laws that he considers the basis of the planned revamp. He calls them a reform puzzle since the reform is impossible without all of them. One of the potential laws would explicitly determine to what extent healthcare would be covered from compulsory health insurance.
The main notion of the ministry, which wants to keep the system's current level of solidarity, is that the patients should contribute to the treatment of light diseases; thus, the system would have enough money to fully cover the treatment of urgent cases and severe and chronic diseases, the treatments of which are so expensive that patients would be not able to afford them.
These include, for example, cancer, cardiovascular diseases, and diabetes. Minister Zajac claims that the healthcare budget is Sk60 billion €1.46 billion) for one year, and these funds should be used for necessary healthcare.
"Manicures and pedicures will not get into this package," reiterated Zajac, who estimated that the average annual contribution of a patient would be Sk600 (€14.6), according to the daily Pravda.
However, the final form and the exact extent of the treatment to be covered by compulsory insurance will be the subject of political consent.
The new proposed laws, which are expected to become effective as of April 1, 2004, would also create the possibility of supplementary health insurance, which would serve to pay for the treatment of diagnoses not covered by compulsory health insurance.
The Health Ministry intends to tackle overemployment in some regions, especially in Bratislava, as well as to reduce the network of healthcare facilities and the debts in the sector.
The debt of the health care sector climbed to almost Sk30 billion (€729.04 million) in mid 2003.
18. Nov 2003 at 0:00 | Jana Liptáková