PRIVATE medical centres began to come into existence as an alternative to state hospitals and doctors in the mid 1990s. Although many patients and physicians now appreciate the individual healthcare approach they provide, centres still face legislative barriers.
The Slovak public and physicians themselves initially accepted the private medical centres with scepticism. People had almost no experience with private doctors and they considered them an unaffordable medical service.
"Of course we have been met with scepticism. Even two years ago, physicians from hospitals gave the impression that as a patient [in a private centre] you had to pay very much for everything," Vlasta Provazníková, owner of PRO BIOS clinic, told The Slovak Spectator.
Provazníková and Dušan Ogurčák, director of the Pro VITAE centre, emphasised that health insurance companies reimburse the basic medical services provided in their centres. A patient pays for above-standard and specialised services.
"A new patient will always be informed about what he is going to pay for in cash and what services will be reimbursed by an insurance company, and to what extent," Provazníková said.
Patients appreciate clear rules and flexible services in the centres. Clients can visit their physicians during office hours lasting till late evening, which is generally not possible in state hospitals and doctor's offices.
People can escape long waits at their doctor's door, which very often occurs in state hospitals even when scheduled in advance. Last, but not least, say Provazníková and Ogurčák, patients and physicians spend their time in a pleasant environment.
"Our clients are mainly people who do not want to waste their time. Our aim is to renew the tradition of family doctors with regular preventative medical examinations and complex healthcare," said Ogurčák.
The Act on Medical Care enabled the establishment of the first private medical centres. Founders had to fulfil strict conditions that have remained almost unchanged. Professional services have to be guaranteed by specialists who have passed at least two state accreditation exams.
A medical centre must be founded by a Slovak citizen. The district authority for physicians grants founding licenses to medical centres, and the Slovak Chamber of Physicians ensures that a professional level of services and equipment is maintained.
Although private doctor's offices and centres often invest a lot of money in providing state-of-the-art treatment, it might happen that some are not allowed to have their services reimbursed by health insurance companies, forcing them to raise prices for their patients.
"This is a measure of former Health Minister Tibor Šagát that I do not consider a reform. In his opinion there were a lot of private health centres and doctors in Slovakia and thus only some of them succeeded to access the 'net' that enables the reimbursement of basic medical services," said Provazníková.
According to her, the state should reinforce the role of private doctor's offices, encourage competition between them, and develop various healthcare grant programmes.
Doctors' offices could carry out many medical services that are now done through hospitals, which would be much cheaper for the state.
Additionally, the two said, private doctors' offices have an individual approach that tends to emphasise prevention, which could save money if diseases are detected in early phases when treatment is less expensive.
"The whole complex of healthcare services helps to reveal hidden risks and prevent health complications," said Ogurčák.
Provazníková considers the impossibility of gaining above-standard healthcare insurance in Slovakia a shortcoming of the current legislation and a barrier to the development of private medical centres.
"The problem is that, in Slovak legislation, everyone must have the same level of healthcare services. Everyone just has to pay the same basic insurance and has the right to get the same services no matter how much he or she earns. Abroad, it is normal to have the possibility of additional healthcare insurance," she added.
New laws proposed by current Health Minister Rudolf Zajac, expected to become effective as of April 1, 2004, should allow the possibility of supplementary health insurance, which would serve to pay for the treatment of diagnoses not covered by compulsory health insurance.
Provazníková welcomed some of Zajac's reforms, saying that, although it may be a hard time for people used to completely free healthcare services, they are finally moving Slovakia closer to foreign standards.
One of the potential new healthcare laws would explicitly determine to what extent healthcare would be covered by compulsory insurance.
The main notion of the ministry, which wants to keep a certain level of uniformity, is that 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. Zajac claims that the healthcare budget is Sk60 billion (€1.46 billion) for one year, and these funds should be used for necessary healthcare.
He said at a recent meeting of cardiologists that, although the Slovak constitution guarantees free healthcare, it is a luxury that "the state cannot afford".
According to him, the constitutional guarantee of free healthcare and education include "a lot of elements from the old times" when Slovakia was a communist state.
After recent changes in the sector, however, Slovak patients are already paying small fees for health services, including Sk20 (€0.50) and Sk50 (€1.20) fees for drug prescriptions, doctor visits, rides in ambulances, and hospital stays.
Apart from the problems of having an aging population and skyrocketing costs for medical treatment, Slovakia is struggling with the results of a far-too-generous healthcare scheme and the constitutional commitment to provide compulsory free health insurance.
The old system was designed to cover regular costs, but it is far from effective in covering new treatments, which can be several times more expensive.
The aging population has further added to the economic burden. While life expectancy is increasing, the number of economically active people, those who contribute most 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 state's lack of drugs for cancer patients was recently leaked to the public.