A PLURALISTIC system in the health insurance market is better than a unitary one as it supports competition and brings innovations. Thus, to improve the level of health care provided it is necessary to continue developing the existing system, believes Katarína Kafková, president of the Association of Health Insurance Companies in Slovakia. The Slovak Spectator spoke with Kafková, whose association’s two members are the private health insurers Dôvera and Union, about the current health insurance system and the government’s present effort to create a single, state-owned health insurer in Slovakia.
The Slovak Spectator (TSS):How do you perceive the proposal of Prime Minister Robert Fico to create one, state, health insurance?
Katarína Kafková (KK): A pluralistic system is undeniably better. A study conducted by the think tank Health Policy Institute (HPI) confirms this. Take for example insurance company reimbursements of health care providers or money spent on hospital medical treatments. Based on the data of ÚDZS (Úrad pre Dohľad nad Zdravotnou Starostlivosťou), the governmental committee responsible for health care oversight, payments of private health insurance companies Dôvera and Union for provided health care to their providers were higher in eight out of nine monitored segments than those paid by the state insurance company, Všeobecná Zdravotná Poisťovňa.
In the same cases the differences in reimbursement for provided health care costs are significant. For example, in surgery this difference was as high as 705 percent in 2011. Thus it is not true that private insurance companies generate profits only through low payments to health care providers. Contrary to this, in most cases they pay more than the state insurer.
The pluralistic system brings innovation, supports competition amongst health care providers resulting in better and more effective health care, fulfils a significant supervisory role, supports the creation of rules and so on.
Almost 2 million citizens have opted for a private health insurer. This number best confirms the fact that the ability to choose an insurer and a variety of services is something that is wanted by those most important in this discussion – people, i.e. the insured. Thus, if we want to improve the level of health care provided, it is necessary to continue developing a pluralistic system, by means of competition and the existence of several health insurers as financial gatekeepers of the health care system.
TSS: What are the pitfalls of the system of one state health insurance company under the current climate in Slovakia?
KK: The Slovak public remembers the time of monopolies and five-year plans, in which there were no profits or losses. The threats of a single insurer are obvious – ineffectiveness, waste and growing corruption leading to dissatisfaction or even frustration among providers and especially among patients. When a citizen is not satisfied with one health insurer, for example, with a waiting period for a certain treatment, he or she will not have a ability to opt freely for alternate insurance, in which he or she could receive treatment earlier. And based on an analysis by HPI, the waiting periods for private insurers are in most cases shorter.
In the event of a single health insurer we also assume there will be a system-wide preference toward state health care providers over non-state, which will limit the ability of a patient to choose a facility. If the patient is currently dissatisfied with his or her health care, he or she will most likely be even more dissatisfied after the planned changes.
TSS: What do you perceive to be the main reason behind the creation of a single health insurer – the profits of private health insurers?
KK: We can only assume based on statements published in the media, but we are convinced that the primary aim is actually to divert attention from the real diseases of the Slovak health care system.
Let’s look at the current situation with public health insurance. During the second half of 2012 a new Pharmacy-based Cost Group (PCG) parameter reflecting costs of treatments of diseases will be implemented into the current re-distribution mechanism, based on which collected insurance premiums are redistributed amongst the health insurance companies. This new parameter will cause reshuffling of at least €15 million from private insurers to the state insurer.
On one hand the private insurers support the introduction of fair rules into the system, but on the other hand it is necessary to say that they generate profits via a responsible approach to their tasks. This means that private insurers will not allow gaps in payment to health care providers because this would create even bigger problems in the health care sector. However, they will have to cover any gaps in the collection of insurance premiums from their own resources. This is also why it is not possible to speak about the profitability of private insurers – during previous years, precisely because of having to cover failed insurance premiums, private insurers also reported losses.