President Andrej Kiska is dissatisfied with the government’s approach to health care and is openly criticising Health Minister Viliam Čislák.
This is the first time Kiska has made direct criticism toward a cabinet member public, as he says that Čislák has failed to respond to mounting scandals in the sector in recent months. The health minister failed to provide any clear information about the measures he took or is planning to take in order to “stop the uneffective and non-transparent spending of money in health care”, Kiska said following his meeting with Čislák on March 16.
Kiska’s criticism was also motivated by Čislák’s statements on Slovak Radio on March 7 that the CT case, a major scandal that forced the resignation of Čislák’s predecessor Zuzana Zvolenská and the parliament speaker Pavol Paška and prompted street protests, was a “pseudo-case” and “business as usual”. Such statements make the personnel changes that took place four months ago at the ministry and in the parliament seem like an empty gesture, according to Kiska.
When Kiska won the presidential election run-off against Prime Minister Robert Fico one year ago, analysts were concerned about the quality of the relations between the presidential office and the government. Kiska’s first year in office has however passed without major public clashes with the government.
Health system causes deaths, says Kiska
In his critical speech Kiska listed a number of health-care-related issues he believes require the attention of the government: the bad atmosphere in the patient-doctor relationship, the non-transparency of the system, the absence of the DRG (diagnosis-related group) system of financing, “which would bring order, greater transparency, and more objectively measurable information”, according to Kiska.
“How is it possible that in all EU countries the DRG has been partially or fully introduced, and not here?” he asked in his speech.
Slovak health care does not have normatively introduced standard diagnostic and treatment procedures, which are a norm in other countries, Kiska said, adding that this often leads to unnecessary deaths.
Kiska also called on the ministry, the public health insurer and other public offices to put together the data they have at their disposal and use it to evaluate the quality and effectiveness of healthcare providers.
Experts on health care mostly agree with Kiska’s reservations towards the state of the healthcare sector.
“The president posed questions that the Medical Trade Unions Association (LOZ) has been posing to in the long run,” LOZ President Peter Visolajský told the Sme daily.
Čislák: we took steps
Čislák did not accept Kiska’s criticism of his department and said among other things the ministry has helped hospitals cope with debts that have accumulated over the course of years. He called Kiska’s speech a pre-planned media performance.
“Regardless the statement of the president, who in the healthcare sector has no responsibility or competencies, the government will continue fulfilling its programme statement in this sector,” Čislák said as quoted by TASR.
Čislák also insisted that in this election term, the ministry has dealt with the salaries of doctors and nurses, started dealing with the lack of general practitioners, reconstructed several hospitals with the use of the EU funds, and “abolished nonsensical fees” patients paid to doctors.
Prior to becoming president, Kiska ran the Dobrý Anjel charity organisation, which works with mainly oncologic patients. In his election campaign he used to stress health-care related problems as major issues the government needs to deal with, and pledged he would keep pushing for improvement.
The achievements listed by Čislák however aren’t what has kept the public focused on the healthcare sector in the past few months, starting in November 2014, when news of the flawed computer tomography (CT) scanner tender broke. This forced the resignation of Zuzana Zvolenská as health minister as well as Renáta Zmajkovičová, a key Smer official, who led supervisory board of the Piešťany hospital which purchased the device, as parliamentary deputy speaker. The scandal eventually led to the resignation of the parliament speaker Pavol Paška, one of Smer’s top officials.
That was when the then state secretary of the Health Ministry Viliam Čislák became the new minister.
The fall of Zvolenská and Paška however did not calm the public anger over dubious deals in the healthcare sector while the protests organised by a number of opposition deputies culminated on November 25 when approximately 5,000 people took to the streets of Bratislava. Kiska also reacted to the scandal, and went to speak to the parliamentarians about the health care issues.
In December, another scandal followed, when the Sme daily and Transparency International Slovensko (TIS) reviewed contracts of four large state hospitals in Trenčín, Banská Bystrica, Trnava and Poprad and found that they will pay external caterers nearly €81 million including VAT over the course of 10 years. After Sme ran the story, these overpriced catering contracts signed with mutually intertwined companies saw the heads of the state-owned hospitals forced out, along with the Health Ministry’s service office head Martin Senčák.
Smaller-scale corruption in health care made the news then in February 2015, when famous cardiac surgeon Viliam Fischer was charged with taking bribes, and a known Bratislava-based GP Peter Lipták spoke about small informal payments he receives from his patients as gifts, provoking massive criticism.
Conflict with the government?
It is the first time that Kiska directly criticised the government and a concrete cabinet member, but that does not mean the president and the government have been of one mind all through the first year of Kiska’s presidency.
Kiska however never directly criticised the government when expressing opinions that differed from the prime minister. That was the case in the foreign and security policy, Institute for Public Affairs President Grigorij Mesežnikov told The Slovak Spectator.
“Now the situation reached the point where problems cannot be criticised from a general viewpoint anymore,” Mesežnikov said, adding that Kiska now seems to be willing to contribute to solving the problems he sees in health care, by calling on the government to present some solutions.
If the government does not want to enter into useless conflicts with the president, it should answer pragmatically, by proposing concrete steps in the healthcare sector, according to Mesežnikov. It wouldn’t be good for the government to try to return these critical words to the president from a pragmatic viewpoint, because the public is sensitive to health care issues, which was proved by the resonance of the CT case among the society.
“The public won’t take the government’s side regarding this issue, unless it presents concrete solutions,” Mesežnikov said.
Though Kiska was unusually critical towards the health minister, it does not mean that he will now maintain the direct, critical tone towards the government in the year ahead of the elections. At the same time, Mesežnikov does not expect the president to remain silent.
19. Mar 2015 at 14:24 | Michaela Terenzani