Slovakia

Background

After splitting from the Czech Republic in 1993, Slovakia moved to a multiple insurance system with several health funds in notional competition. These funds were paid from employee and employer contributions of respectively 4% and 10% of gross wages. People could freely choose between various sickness funds, but the funds offered the same benefit catalogue at the same conditions. Price and wage negotiations between insurers and providers took place at a collective level. GP surgeries were privatised, while hospitals and clinics remained state property.

Mean life expectancy rose, but the system became increasingly strained by rapidly rising expenditures and debt levels. Hospitals at the edge of bankruptcy were repeatedly bailed out by the government, which weakened financial accountability and prevented structural adjustment. Due to long waiting lists, informal patient-doctor payments lingered on. According to one survey, “gratitude payments” took place in about 70% of all specialists’ visits.

Recent years

Between 2002 and 2006, the government of Prime Minister Mikulas Dzurinda implemented perhaps the most profound reforms of health care of the CEE region. As a first measure, patient fees were introduced to limit demand, which was ahead of most of Europe on many indicators. After this financial stabilisation measure, a series of structural reforms were enacted. The principle of collective bargaining between all sickness funds and all providers was abandoned. To encourage competition between providers, sickness funds were no longer obliged to maintain contracts with every provider in the country, but were left free to contract with those they considered most competent. To provide sickeness funds with an incentive to purchase health services efficiently, they were also permitted to earn profits. Hospitals were transformed into joint stock companies, a move which gave them budgetary autonomy but also exposed them to the risk of bankruptcy. Later on, some hospitals and three smaller health funds were privatised. 

Current situation

Following the 2006 election, many elements of the reform agenda were reversed by the new Social Democrat administration. Privatisations were ended, patient fees abolished, and recently, health funds were once again prohibited from making profits. Still, Slovakia’s health system can be described as a mix between a public and private system, since it has multiple insurers, some private providers and elements of selective contracting. Today, the reform debate is still going on, and it is not yet obvious where Slovakia’s health care system is heading in the near future.