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SIX NEW LAWS PROMISE IMPROVED EFFICIENCY AND GREATER TRANSPARENCY

Healthcare reform squeaks through

THE HEALTHCARE system is set for a major overhaul following the passage of six laws that, according to the Health Ministry, will open the way for a more efficient and transparent healthcare service.
The reform is one of the commitments the current cabinet made in its electoral programme, which the four ruling parties approved after the 2002 parliamentary elections.

THE HEALTHCARE system is set for a major overhaul following the passage of six laws that, according to the Health Ministry, will open the way for a more efficient and transparent healthcare service.

The reform is one of the commitments the current cabinet made in its electoral programme, which the four ruling parties approved after the 2002 parliamentary elections.

From a political standpoint the endorsement of the laws provides a boost for the ruling coalition, who lost its parliamentary majority in 2003. With just 70 ruling coalition MPs out of 150, it needed opposition support to fulfill its electoral promises.

On September 21 the first two health reform laws, the laws on health insurance and health insurance companies, were passed with a strong majority of 81 votes of the 147 MPs present.

Bolstered by this success, Health Minister Rudolf Zajac confidently told journalists: "We are going to go ahead with the [remaining four] laws and I am convinced that Slovakia will get a health service we can be proud of."

Shortly after the passage of the remaining four laws on September 22 Zajac said he expected the new healthcare system to bring about "a considerable improvement of medical care, better quality, less corruption, more pleasant staff and hospitals".

Over the two days of voting the coalition was backed by several independent MPs, former members of the opposition Movement for a Democratic Slovakia, as well as the former Slovak Communist Party member Herman Arvay, and former members of the ruling Slovak Democratic and Christian Union, Ivan Šimko and Alexej Ivanko. Only Christian Democrat Mária Sabolová abstained from voting.

The biggest surprise, however, came from the coalition's harshest opponent, opposition MP Bohumil Hanzel from Smer, who voted for the package in its entiriety. The Smer MP, along with Ivan Šimko, may face expulsion from their respective parties for taking individual stands.

Smer chairman Robert Fico said that his party would "not tolerate such breakaways" [from the party's official line]. Smer has already appealed to President Ivan Gašparvič to veto the laws.

Gašparovič's spokesman Marek Trubač said that the president was not going to advance any comment at this stage. If the president does veto the laws they will be returned to parliament for further debate. And should 76 MPs repeatedly support the laws it will finally override the presidential veto. Considering that a majority of 80 consistently backed reform, the status quo seems likely to be maintained.

Grigorij Mesežnikov, head of the Institute for Public Affairs think tank told The Slovak Spectator on September 22 that the successful passage of the laws was a "political victory for the coalition, which has a minority position in the parliament.

"It also suggests that the coalition will be able to secure future support for its initiatives. The reason for this is very likely due to effective 'backstage' lobbying of the independent MPs who, in this case, supported the reform," Mesežnikov said.

Slovakia's ambitious health plans received the backing of the World Bank, which provided a loan worth Sk2.8 billion (€70 million), monies which can be drawn on until 2007.

The six laws should gradually take effect at the start of next year.

Although Minister Zajac insisted that Slovaks would not pay more for health services than they currently do, opposition parties expect major hikes.

Apart from their regular health insurance payments Slovaks currently pay Sk20 (€0.5) for every visit to a doctor, and the same fee is charged for every drug prescription issued. Hospital fees are Sk50 (€1.3) per day. However, there are exemptions from these fees, for mothers with small children as well as for socially disadvantaged people.

Political opponents of the new laws insist that the "goal of this reform is that people will be obliged to contribute money which will profit private companies", Smer Deputy Chairman Pavol Paška said at a press conference on September 22.

Minister Zajac rejects such allegations.

The new laws will lay the foundation for the transformation of hospitals and health care insurance firms into joint stock companies. Managers will be responsible for the financial situation of their institutions. Advocates of the reform say that the people in charge of hospitals will be forced to operate effectively and try to provide quality services because the state will no longer be liable for their debts.

The Slovak healthcare sector is still burdened with billions of crowns in debts, which the state is now gradually eliminating through state-controlled joint stock company Veriteľ.

Under the new system the state will no longer serve as the last resort to save mismanaged healthcare operations. It is also expected that some ineffective institutions will be forced to close.


HEALTH LAWS


Law on health insurance - introduces two types of insurance: public, which is obligatory, and voluntary. The latter would cover services that go beyond the scope of general insurance defined.

Law on health insurance companies - transforms the firms into joint stock companies. The biggest health insurance company, Všeobecná zdravotná poisťovňa and Spoločná zdravotná poisťovňa, however, will be 100 percent state owned.

Law on health care - defines healthcare and individual services.

Law on the scope of health care - determines which diagnoses will be fully covered by public health insurance and which will be partially or fully paid by the patients.

Law on health care providers - transforms hospitals into joint stock companies.

Law on ambulance services - redefines ambulance services and introduces sanctions for failure to deliver emergency assistance to patients.


Healthcare Ministry

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