Health Ministry and doctors butt heads

IN HIS attempt to heal ailing public hospitals burdened with large debts, Health Minister Ivan Uhliarik has been pushing the idea of transforming them into joint-stock companies. But the Medical Trade Unions Association (LOZ) does not think the minister has the right prescription and has launched a protest campaign with four demands, including dumping the minister’s transformation idea.

Doctors may stop their rounds.Doctors may stop their rounds. (Source: Sme - Tomáš Benedikovič)

IN HIS attempt to heal ailing public hospitals burdened with large debts, Health Minister Ivan Uhliarik has been pushing the idea of transforming them into joint-stock companies. But the Medical Trade Unions Association (LOZ) does not think the minister has the right prescription and has launched a protest campaign with four demands, including dumping the minister’s transformation idea.

Inspired by doctors in the Czech Republic who earlier this year threatened mass resignations, LOZ is asking doctors in Slovakia’s public hospitals to sign notices terminating their employment contracts unless their four demands are met.

“LOZ cannot look on any longer at how Slovakia’s health care is being driven to destruction by incompetent decisions from the Health Ministry,” LOZ states on its website. “It is now a sinking ship on which all are sailing together – doctors, nurses, and also our patients.”

LOZ has taken its four demands to Minister Uhliarik as well as to Prime Minister Iveta Radičová, saying their aim is to reverse the current crisis situation in Slovakia’s health-care system and to secure better health care for citizens in the future. The four demands are for hospitals to observe the requirements of the Labour Code, to change the current funding system for health care, to stop the transformation of public hospitals into joint-stock companies, and to gradually increase the salaries of health-care employees.

The chairman of LOZ, Miroslav Kollár, has said that the doctors believe achieving all four of their demands is the only way to achieve comprehensive reform of the health-care system but the doctors’ demand to stop the transformation of their hospitals to joint-stock companies seems to have become the most contentious issue between the ministry and LOZ.

In its response to the demands from LOZ, the Ministry of Health wrote in mid July that it agrees with nearly all of the doctors’ points but insists on transforming the structure of the hospitals, a step that has already been approved by Slovakia’s parliament. The ministry says that transforming the hospitals into joint-stock companies will provide a more transparent way to gauge the economic performance of medical facilities.

“The aim of the transformation is more effective and transparent operation of hospitals,” Katarína Zollerová, the spokesperson for the Health Ministry, told The Slovak Spectator. “Joint-stock companies, contrary to government-subsidised organisations, must use transparent bookkeeping according to standardised rules, must undergo annual audits and must publish financial statements. The management of joint-stock companies is under much greater pressure to operate efficiently than government-subsidised facilities.”

Kollár responded to that argument by saying the hospitals will still not operate with a balanced budget after such a change in their structure because the hospitals are dependent on payments from Slovakia’s health insurance companies and LOZ believes the insurers’ reimbursements do not reflect the real cost of hospital treatment and care, the SITA newswire wrote.

LOZ states on its website that Slovakia’s current legislation makes payment of health insurance obligatory as well as the hospitals’ duty to provide treatment to patients, but adds that there is no law requiring health insurance companies to cover the actual costs for the medical care the hospitals provide.

Kollár stated that his organisation believes that less money coming to the hospitals will be reflected in a drop in the quantity as well as the quality of health-care services provided in the hospitals as well as an increase in fees. LOZ has also said it is fearful of possible distraint proceedings against the hospitals to collect debts as well as by the possible sale or privatisation of hospitals by ‘various groups’ that Kollár did not further identify, the SITA newswire wrote.

Zollerová told The Slovak Spectator that after transformation of the hospitals into joint-stock companies the state will remain the exclusive owner of 100 percent of the shares in each hospital.

“The government is not pondering any sale of the shares,” Zollerová stated, adding neither the past government nor the current government had sold any of the shares of six hospitals that were transformed into joint-stock companies in 2006. “This will also be the case after the origination of the additional joint-stock companies.”

The plan is to transform public hospitals under the control of the Ministry of Health into joint-stock companies by the end of 2011, though that deadline might be postponed by six months for certain hospitals. Hospitals not operated by the Ministry of Health are expected to change their form by mid 2012. The state will be the legal founder and 100-percent shareowner of the newly-created joint-stock hospitals and the ministries that currently control the hospitals will continue to administer the hospitals on behalf of the state. The plan calls for 31 facilities to be transformed into joint-stock companies and the cabinet has already allocated €350 million to cover those facilities’ current debts. The parliament approved its allocation on September 8.

In late August LOZ started collecting signed notices from doctors in which they state they are terminating their employment contract with their health-care facility. LOZ had previously said it had received commitments from 3,830 doctors working in 51 hospitals to sign a notice of termination of their employment contract. LOZ estimates that about 5,300 doctors work in public hospitals in Slovakia.

The first information about mass termination notices ‘on paper’ came from the Prešov-based Ján Adam Reiman Faculty Hospital and Polyclinic, with Michal Polician, the head of the local trade union telling SITA that about half of 300 doctors working in the hospital indicated signing the termination notices. Polician did not specify exactly how many notices had already been signed.

Polician said the doctors’ main reason for signing the notices is disagreement with the idea of fast transforming their hospital into a joint-stock company, as well as low salaries. Polician said a doctor’s average monthly salary at the hospital is €1,500 and that includes all supplemental pay and overtime pay. He added that after working for 33 years as a surgeon his monthly salary is €1,200 without supplemental payments and that is why he had signed a termination notice, SITA wrote.

LOZ told The Slovak Spectator that it is satisfied with its campaign. "We can say for now that everything is going according to plan," adding that in the end even a higher number of doctors may sign the termination notices. "The notices will be delivered to all hospitals at the same moment."

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