Prevention is cheaper than cure

A glossary of words as well as an exercise related to this article are also published online.

Examinations can detect the beginnings of disease.Examinations can detect the beginnings of disease. (Source: SME)

A glossary of words as well as an exercise related to this article are also published online.

PREVENTING diseases and medical conditions is cheaper and more effective than treating them, according to health-care experts. While the average price for a preventive examination is approximately €50, treating cancer once it has been detected at an early stage costs €550 on average. Treatment of a non-metastatic malignant tumour costs about €1,660 per month, while a metastatic tumour costs €3,100 per month, according to Petra Balážová, spokesperson for the state-run health insurer Všeobecná Zdravotná Poisťovňa (VšZP).

Generally, Slovaks rarely visit their doctors for routine check-ups or preventive examinations, and only one quarter of adult Slovaks visit a general practitioner to undergo such examinations, Health Ministry spokesperson Zuzana Čižmáriková said.

“The numbers [related to] preventive examinations are really low in Slovakia,” Čižmáriková told The Slovak Spectator. “People should realise that prevention is the best option for preventing disease or diagnosing it as soon as possible.”

Since prevention is more economically beneficial for patients as well as public finances, the amendment to the law on the range of health care covered by the state, effective as of April 1, 2013, extends the range and frequency of some preventive medical examinations, based on the needs that practice has revealed, Čižmáriková said.

According to the new rules, the age of a patient who is entitled to one urological examination covered by public finances every three years has decreased from 50 to 40, if one’s father, son or brother has been diagnosed with prostate cancer. Patients without such relatives are entitled to an examination once every three years, as before. Furthermore, health insurance holders older than 40 may have their cholesterol checked every two years as opposed to only once, at the age of 40 or 41, as defined by the previous version of the law, according to Balážová.

While 25 percent of people undergo preventive examinations by a general practitioner, 90 percent of Slovaks visit the dentist annually for routine check-ups, since patients who do not are required by law to pay out of pocket for all dental services the following year. In the case of specialists, around 40 percent of women undergo gynaecological examinations each year, while approximately 20 percent of women undergo breast examinations. Only about 2 percent of men undergo urological examinations to detect or prevent prostate cancer, according to Čižmáriková.

According to VšZP data, 1,995,433 VšZP policy holders visited the dentist for a preventive examination in 2011, 435,556 visited a general practitioner for adults and 3,981 visited a gastroenterologist, Balážová said. Women are more disciplined than men when it comes to scheduling preventive examinations, and people with a higher level of education have more preventive examinations then less educated people, she said, adding that men over 45 go in for examinations more often than men under 45, she added.

What options do we have?

Along with urological examinations, patients over the age of 18 are entitled to one preventive examination by a general practitioner every two years. Children younger than one year may be examined nine times by a paediatrician for free; children 18 months of age are entitled to one free check-up, while children between three and 18 are entitled to one examination every two years. Children under 18 are also entitled to two free preventive dental examinations per year, while people over 18 are allowed one per year, according to the Pravda daily, citing VšZP.

Pregnant women are entitled to two fully covered dental check-ups during pregnancy and one gynaecological examination per month, followed by one preventive gynaecological examination six weeks after giving birth. Women older than 18, or under 18 but after giving birth, receive one free preventive gynaecological examination per year.

Public funding also covers one yearly preventive examination for blood or organ donors. Colon and rectal examinations for patients over 50 are covered once every ten years. Those with an increased risk of colon or rectal cancer qualify for a free screening every five years. Patients under 18 involved in organised sports are eligible for one partially reimbursed preventive examination with a sports physician per year, Pravda reported.

However, visiting a doctor is not the only way to prevent diseases or medical conditions. Statistics show that lifestyle has a significant impact on people’s health, Monika Šimunová, the PR specialist for Dôvera, private health insurance company told The Slovak Spectator.

“A good example is obesity, which is related to proper diet and sufficient movement,” Šimunová said. “[Living a healthy lifestyle] a person may evade many diseases and complications such as diabetes, high blood pressure, cardiovascular disease and so on.”

Doctors’ behaviour

Preventive examinations are a patient’s right, not an obligation. Therefore physicians must not reject patients on the basis that they have failed to undergo preventive check-ups, according to Šimunová.

On the other hand, Dôvera has reported cases in which doctors claimed to have conducted a preventive examination on a patient, when in reality they had not. To prevent such cases, the insurance company runs an electronic service through which an insured person can check the services reported by a doctor. If they discover that a doctor has filed a fictitious examination or health-care service, they can report it to Dôvera. The insurance company has special doctors who conduct medical peer reviews, who contact doctors suspected of this practice and ask them why such a service was reported, Šimunová said.

VšZP regularly conducts inspections in every field of health care, and when inconsistencies are detected, it investigates the cases more deeply, Balážová said, adding that fictitious medical services are among the most frequently detected problems.

Circulatory diseases are the leading cause of death in Slovakia

THE LIFE expectancy of Slovaks is, on average, lower than that of other Europeans, according to a report by the Public Health Authority (ÚVZ). Slovak males, for example, die eight years earlier than their Swedish and Swiss counterparts, who have the longest lifespan in Europe, reaching an average age of 79.9 in 2009. The lifespan of Slovak women was six years shorter than that of French women, who, on average, lived to 85 in 2009, ÚVZ spokesperson Lenka Skalická the told The Slovak Spectator.

According to the ÚVZ report, documenting the health of the Slovak population between 2009 and 2011, the annual mortality rate has stayed below 10 deaths per 1,000 persons since 1993. The report says that 25,106 women and 26,797 men died in 2011, and the average lifespan was 67.9 years for males and 76.6 for women. The most common causes of death are circulatory diseases, which in 2011 caused 45.9 percent of deaths among men and 59.8 percent of deaths among women.

Furthermore, 26.2 percent of men and 20.1 percent of women died from cancer, 7 percent of men and 5.6 percent of women died from respiratory diseases, and diseases of the digestive system killed 6.4 percent of men and 4.6 percent of women. Also, 8 percent of men and 2.7 percent of women died from external causes in 2011, according to the ÚVZ report.

The most frequently occurring diseases in Slovakia are cardiovascular and respiratory diseases and malignant tumours. There are also an increasing number of asthma cases, as well as instances of chronic obstructive pulmonary disease. A common cause of disability and death are musculoskeletal and psychiatric disorders, and the ÚVZ has noted an increase in the prevalence of type II diabetes, Skalická said.

Although many of these diseases are influenced by uncontrollable factors, like genetics, gender or age, lifestyle factors, like diet, environment, lack of exercise, smoking, stress, excessive alcohol consumption and so on, also play a crucial role, Skalická said. By Roman Cuprik

This article is published as part of Spectator College, a programme created by The Slovak Spectator with the support of Sugarbooks, a distributor of foreign language books.

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