Health care needs cleaning, new minister could deliver

No major reform or brand new vision for the health care sector planned, but contains some positive steps that could make the new minister, who entered the sector as a crisis manager with little experience in health care, a good caretaker in the next four years.

(Source: TASR)

In health care, just as in the rest of the programme statement, experts complain about the text being too vague and lacking in concrete steps, but they also not that if the measures defined in the programme are carried out, the country's ailing health care sector would markedly improve.

“While education really does need a reform, health care will do with just some cleaning,” Tomáš Szalay from the Health Policy Institute (HPI) said during the April 18 debate. It’s enough that hospitals stop buying overpriced CT scanners and it would be a step forward, he added.

The programme statement on health care was drafted by Health Minister Tomas Drucker, who was nominated by the ruling Smer party after it announced they wanted a crisis manager. It is clear now that he is unlikely to change the mindset in the system, but there are some concrete measures poking out of the programme statement that could bring some improvement, according to Szalay.

The two major changes, diagnose-related groups (DRG) system and e-Health system, that the previous government pledged but did not manage to fully introduce, should be finalised under Drucker. He pledged to have DRG fully operational by the start of 2017, and e-Health in the course of 2017.

Analyst Dušan Zachar, on the blog of INEKO think tank, calls such a deadline for e-Health ambitious but admits it is “probably possible to meet only with competent and engaged leadership and full engagement of the department”.

Motivations need change

The government declares in the programme statement that “zero tolerance principle” must be applied toward wasteful spending “at all levels of health care”. Experts on health care praise such resolution but stress that the government did not specify how this should be achieved in concrete steps.

The "value for money" philosophy should be reflected in health care in the coming four years, the programme statement suggests. As part of that philosophy, the government aims to systematically revise the public expenditure within its term in office, and compare the inputs and outputs of the public sector regularly and systematically with the best practices at home and abroad. Health care, along with transport and informatisation of public administration (the three of which represent 40 percent of all the expenses of the public administration, as stated in the government’s programme), should be the first areas to undergo such revisions.

The government pledges to “immediately start” with gradual centralisation of transparent procurement in state hospitals under the ministry, and the publishing of comparative price lists". Experts welcome such step in general. Szalay however noted that better procurement rules don’t necessarily mean functioning better.

Szalay believes that what could help more than changing procurement rules would be to change the motivations for those involved not to steal.

“The problem of health care that the programme statement does not define is the way motivations work,” Szalay said. For instance, general practitioners are paid per capita, while specialists get payments for individual treatments. Doctors and hospitals are rewarded for the process, but not for solving the problems of the patient, he added.

Multi-source financing mentioned

The government declares the principle ‘patient comes first’ among one of its five main pillars in health care for the next four years, and promises to improve the often alarming situation of patients in hospitals and in doctor's office by introducing maximum waiting time for planned surgeries and renovating the buildings of hospitals in the regions.

The Health Ministry also promises to “prepare the introduction of transparent rules for payments for patients and creating the system of multi-source financing”.

Szalay finds it surprising that Drucker as a nominee of Smer is ready to open the space for payments.

Zachar on the blog of INEKO noted that one can only deduce what the ministry means by “multi-source financing” and offers that it probably means the system of optional health insurance or payments for non-standard treatment and services. He however noted that the Slovak laws allow for such system but in practice there providers are not sufficiently motivated to offer such above-standard services.

Nurses are unhappy

The Health Ministry claims in the programme statement that health care workers should be paid based on merits. Nurses, who protested over their salaries and their work conditions just before the parliamentary election, agree with such principle, but note that it should be applied to all health care workers equally.

However, representatives of nurses who have met Drucker to talk about the programme statement before it was drafted say that they are unhappy with its final version. None of the three tasks that they requested to have incorporated in the programme statement appeared in the final draft. It also does not specify what it plans to do with salaries of health care workers.

“The programme statement is a big disappointment for us, because there is no hope for nurses in it,” the president of nurses’ chamber Iveta Lazorova said as quoted by the TASR newswire.

The nurses demanded that the government deal with the lack of health care workers and mainly nurses. They claim that that there are 12,460 nurses missing in the system. Another demand was to create the position of the so-called ‘ministerial nurse’ who should lead the department of nursing at the ministry.

“Nursing is key also due to the aging of population,” Lazorova said and suggested the ministry should reflect it too in its organisational structure.

Quality indicators missing

Zachar would expect the government to introduce a comprehensible system of measuring and publishing of production, quality, and effectiveness of health care providers. With such system, the providers could then be rewarded for their services also based on the quality and effectiveness indicators.

While the debts of hospitals have been on the new health minister’s plate ever since he entered the office, and it is expected that the ministry will come up with a way to cancel hospital debts, Zachar pointed out that there is no mention of the way the government is planning to deal with the problem in its programme statement.

He also pointed out the problem of long-term financial sustainability of health care system due to the rising costs and falling income, driven by Slovakia’s aging population, which is not addressed in the programme statement at all. 

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