Healthcare in Slovakia

Healthcare in Slovakia has features of the Bismarck, the Beveridge and the National Health Insurance systems. It has public health system paid largely from taxation. The cost of national health insurance is shared between the employees and the employers. The part of these taxes are paid by the employees as a deduction from theirs wages and the remaining part of these taxes is paid as compulsory contribution by employers. Sole traders pay the full amount of these taxes.

These taxes are managed by health insurance companies. Current healthcare system has 3 health insurance companies, namely Union (12,4%), Dôvera (32,4%) and Všeobecná zdravotná poisťovňa (55,2%)(market share). Všeobecná zdravotná poisťovňa is a state-run insurance company, the other two are private. These insurance companies have contracts with outpatient clinics, hospitals, rehabilitation centres, pharmacies, etc. Despite this, not everywhere and not always the insurance company covers the costs. The costs are not covered for all medicines, or the full price of them. Also, it is not covered dental treatment.

The government pays health insurance for childrens, students, pensioners, invalids, people performing activities for a church, religious or charitable community etc.

According to the new legislation valid from 1.1.2024, the employees contribute 4% (at least 10,75 EUR) and the employers contribute 11% (at least 29,57). In case of invalidity, contribution is reduced by half.

Medical procedures are assigned an artificial value in ‘points’ which is converted to real monetary value by the health insurance company. General practitioners get a capitation payment for each registered patient. There are reimbursement limits, and these can be exceeded in respect of individual patients by negotiation.

International comparasion
It was placed 17th in Europe by the Euro health consumer index (EHCI) in 2024. It was compared 35 systems in 2024.

Slovak’s heatlh care system was given 45th worldwide in 2023.(statista)

In 2022, healthcare system was placed 35th (health spending), 13th (hospital beds), 10th (length of hospital stay) and 33rd (life expentancy at birth).

Finance and resources
In 2023, the Slovak Republic spends $2756 per capita on health, less than the OECD average of $4986 (USD PPP).$2210 was from government/compulsory source and voluntary source was $546. The voluntary contribution was the third lowest among the European countries compared. Lower voluntary contributions were already only in the health systems of Croatia and Romania $2756 per capita on health is equal to 7.8% of GDP, compared to 9.2% on average in the OECD. There are 3.7 practising doctors per 1,000 population (OECD average 3.7) and 5.7 practising nurses (OECD average 9.2). The Slovak Republic has 5.7 hospital beds per 1,000 population, more than the OECD average of 4.3. Financial coverage, with 80% of spending covered by mandatory prepayment, was higher than the OECD average of 76%. Out-of-pocket spending, at 19% of health expenditure, was similar to the OECD average of 18%. 

Contributions from the state budget are essential. For example, the state payments of hospitals debt. The state has been giving hospitals financial injections for a long time. In 2022, the state helped hospitals in this way to the tune of 258 million euros. At the end of 2023, the social insurance company registered a debt of 415 million euros. In 2023 alone, this debt increased by 198 million.

Organization and structure
The Slovak health sector consists of public and private sectors. The public sector includes state hospitals, outpatient clinics and health centres, which are financed from the state budget and through compulsory health insurance. These facilities provide a wide range of health services, from primary care to specialised hospital treatment.

There are 44 state hospitals. Currently, hospitals in Slovakia are categorised into 5 categories. From highly skilled to standard and acute care in a city or region. The only hospital in the highest fifth category is the University Hospital in Bratislava, where the most demanding surgical procedures such as heart transplants are performed. The need to build a new faculty hospital at the Razsochy site in Bratislava has been discussed for a longer period of time. However, construction has not yet started. There are also so-called partner hospitals. These hospitals complement the scope of the compulsory programmes of the main hospitals. In addition to the legislative requirements, the condition of the main and partner hospitals is their distance. The journey between them must not take more than 15 minutes.

The private sector includes private medical clinics, hospitals and outpatient clinics, which are financed by fees for services. These facilities offer alternative treatment options and often specialise in particular areas of healthcare.

One of the most powerful private financial entities is the financial group Penta. It owns a network of hospitals, polyclinics, pharmacies and a health insurance company Dôvera. There are several controversies associated with the Penta. For example, there is a direct conflict of interest between the insurer and the provider, which distorts competition in the market. Another controversies are the alleged lobbying among politicians and violation of the law to provide free treatment in their clinics. Nevertheless, it is difficult to assess whether these negatives outweigh the positives.

Personnel problems in Slovak healthcare
At the beginning of 2023, the Fiscal Responsibility Council made a projection of the evolution of the number of medical staff. Here are its conclusions.

The number of doctors is gradually increasing and the number of doctors going abroad dropped significantly a few years ago. However, even this increase is not sufficient to maintain the current level of care for the ageing population. To reach this level, the number of doctors would need to increase by 4% in the long term compared to current trends. This could be achieved by changing the policy of the medical faculty. The current situation is that medical faculties educate up to 40% of foreign students (announced plans are approaching 50%) at the expense of the needs of the Slovak health sector, which is contrary to the public interest. This opens up space for public policy to stimulate the necessary changes.

A more serious problem will be the shortage of 'nursing' occupations, as the number of nurses will start to decline over the next few years due to the age structure and the shortage of young nurses, and the rate of decline will gradually accelerate over the next few years. Therefore, the biggest challenge for health care staffing policy is to significantly increase nurse retention+(the budget change council used a different methodology for defining a nurse than the oecd uses for the purposes of the article. This group is referred to as nurses+) in the department and to significantly increase the number of young people trained in these areas and increase their motivation to enter the profession. health department. Increasing their wages and making changes to facilitate work-life balance, improving their skills and access to education is key.

Closer cooperation between the different types of "nurses", for instance in retirement homes, would help to promote the interests of nurses, as there is often competition between them today. It is also important to make full use of the education and skills of each type, especially of graduates of nursing schools (without subsequent university education), whose positions appear to be undervalued and inefficient for the system, given the length and nature of their studies.

eHealth system
An eHealth system, administered by the National Healthcare Information Centre was launched in 2018. 92 hospitals were connected to the system. All outpatients’ departments are required to participate. Online medical records are now linked to ID cards. Medication can be prescribed on line and pharmacies can also access the records.