DISSATISFIED clients of health insurance companies in Slovakia are free to dump their present provider and try out another of the two state-run and three private health insurance companies operating in the market. According to the law, Slovaks can move to a new insurer as of January, providing they decide by the end of the preceding September.
Insurers have therefore been courting clients through billboards and ads, but neither observers nor healthcare authorities expect any dramatic migration of clients between insurers.
Meanwhile, a healthcare think-tank released a ranking of health insurers which was immediately followed by a separate assessment of the same companies by the country’s healthcare regulatory authority. Clients may be forgiven for being confused since the two assessments arrived at a completely opposite set of conclusions: the think-tank, the Health Policy Institute (HPI), put the largest state health insurer, Všeobecná zdravotná poisťovňa (VšZP), at the very bottom of its chart, while the Healthcare Supervision Office ranked the same insurer as the best in the market.
Both the Health Ministry and the supervision authority attacked the HPI for what they called its misleading and biased approach. The Healthcare Supervision Office also said that the HPI, by ranking them the highest in its chart, was part of a campaign on behalf of private health insurers. The think-tank, in which some members of the reform team of former health minister Rudolf Zajac are involved, insisted that its methodology meets international standards and that the supervision office’s methodology is wrong.
The HPI ranked the private insurer Dôvera the highest, followed by private insurers Union and Apollo. The state-run insurer Spoločná zdravotná poisťovňa (SZP) was rated fourth, with VšZP bringing up the rear.
The Healthcare Supervision Office, by contrast, said that VšZP was the best insurer, followed by SZP and Apollo. It ranked Dôvera fourth, and Union last.
The reaction of the insurers to the HPI ranking differed depending on how they ended up on the HPI chart: Dôvera welcomed the HPI initiative; SZP said it was ‘damaging’.
While the supervision office looked solely at the amount of money the insurance company spent per insured person annually, the HPI measured their performance in seven main areas.
The areas the HPI measured were financial stability, operational processes, business profile, relations with healthcare providers, the quality of services provided to policyholders and client satisfaction, attributing different weights to each, Angelika Szalayová, an analyst with the HPI, told The Slovak Spectator.
Dôvera the highest-ranked insurer collected the highest points in four areas: operational processes, business profile, relations with healthcare providers and services to clients. But according to the HPI, “surprisingly patient management is among the weak sides of the insurer, where it scored zero. The insurer is also unsuccessful in collection of premiums.”
In the case of VšZP, the insurer with the lowest ranking, the HPI noted selective contracting and the growth of revenues among its strengths.
After Apollo, VšZP has the widest access to contracted healthcare providers. The insurer last year lost very few clients, according to HPI.
“Financial stability is VšZP’s greatest weakness,” reads the HPI report. The think-tank also said that the state-run insurer has the worst price conditions and enjoys the lowest satisfaction among physicians.
The Healthcare Supervision Office released its assessment of health insurers on September 5, shortly after the HPI’s was released, with its chairman, Richard Demovič, suggesting that he did not want the office to be dragged into the creation of rankings and tables.
“We can evaluate health insurers from different aspects but I think that for the policyholder what is important is what happens with the funds that the insurer manages,” said Demovič, adding that the key factor is how much funds a health insurer channels for healthcare to each insured person per year.
The oversight office said it is its responsibility to provide citizens with “objective, unbiased, undistorted and unmanipulated data about the functioning of health insurers,” according to an official release by the office.
“The highest volume of finances used to cover healthcare per insured person was paid by the VšZP,” said Demovič.
According to the office, the least amounts used to cover healthcare per insured person were spent by Európska Zdravotná Poisťovňa, which has already withdrawn from the Slovak market, and Union.
The average expenses per insured person are Sk15,703, with VšZP spending Sk17,466 per patient on average; the SZP spent Sk16,016 and Dôvera Sk13,832. Apollo spent Sk14,774 per per insured person and Union spent Sk8,730.
“The sum a health insurer pays for healthcare does not necessarily indicate the quality of the care,” Szalayová told The Slovak Spectator. “For us, the degree of access that policyholders have to healthcare, or how long they have to wait for services, has greater weight”.
She also said that the numbers that the healthcare oversight authority provided contain a basic methodological mistake since the office disregards the difference in the volume of funds the health insurers have at their disposal. In Slovakia, healthcare funds are redistributed to insurers on the basis of how risky their clients are.
It means that if a health insurer has, for example, many clients aged over 60 - as does VšZP - it will have received more transfers to cover payments for these policy holders, since it is statistically proven that people aged over 60 have expenses six times higher than 25-year-olds, said Szalayová.
Responding to criticism that the HPI manipulated its ratings, Szalayová said that the think-tank first did an in-depth analysis of how agencies in other countries assess the quality of health insurance, for example in the United States, Switzerland, Germany and Australia.
The timing of the release was, according to Szalayova, partly linked to the availability of data since some of that covering 2007 was only released on June 30. But she also acknowledged that the HPI was engaged in an effort to help citizens decide which health insurer to choose if they were unhappy with their existing one.
“Publishing the data two weeks after the pre-registration deadline would have been unfair to policyholders,” Szalayová said.
The HPI does not expect to see significant migration of clients between insurers.
Swapping insurers
In 2008, 230,000 people switched health insurers, 500,000 fewer than in 2007. Last year, VšZP lost 13,603 clients by the September 30 deadline.
But since the insurer has more than 2.9 million clients, the drop has not resulted in any significant change. The other public insurer, SZP, lost 7,747 policyholders insuring 590,936 clients in 2008.
Of the private insurers, Union suffered the biggest drop, losing one-quarter of its clients. It lost 120,082 clients and kept 325,976 clients. Conversely, Dôvera experienced the greatest growth, gaining 83,892 clients, which gave the insurer a total of 842,700 clients for 2008. Zdravotná Poisťovňa Apollo gained 1,749 new policyholders, bringing its total to 430,761 clients in 2008. The fourth private insurer, Európska Zdravotná Poisťovňa, gained 55,791 clients, doubling its clientele to 124,658 in 2008. However, the insurer withdrew from the Slovak market earlier this year, citing unfavourable business conditions as the reason for its departure.
VšZP maintained its top position with a market share of 55.5 percent. Dôvera, with its 16.3-percent market share, came second, followed by SZP, with an 11.1-percent market share.
