While the countries of Western Europe regularly rank among the top in the provision of health care, Slovakia has long been at the bottom of the rankings. And differences in approach to solving problems and achieving goals are to blame – among other things. “The difference between the most successful countries and us is that, when we find that we are not achieving the goal, we usually change or cancel the plan. However, successful countries do not give up, but look for ways to fulfill their goals. And that’s the approach we should follow.” he announced during the first day of the conference FALL ITAPA 2024 Kamil Šaško, Minister of Health of the Slovak Republic. As he further pointed out, looking for an answer to the question of where our healthcare should be in ten years is not correct. “We can draw any visions, but I’m talking about concrete steps: what we have to do already in the first quarter of next year and during 2025. The key is to conduct an audit, introduce effective central procurement, or launch an analysis of economically justified costs, so that we know exactly what is efficient in the system and what is not.’
The situation in the healthcare sector also worries doctors. More than 3,300 of them filed their resignations in protest against the current situation. They are willing to withdraw their resignations if the government starts fulfilling their demands as stated in the memorandum. One of the key ones is the government’s public statement that it does not plan to transform state hospitals into joint-stock companies. “We have to make the health care system more efficient at various levels and stop the constant indebtedness. That is the essence that needs to be worked on, not the question of whether the system will be transformed. The transformation of state hospitals into joint-stock companies is not the goal of the Slovak government,” explained Kamil Šaško at ITAPA.
Minister of Health Kamil Šaško
FUNDING STATE HOSPITALS IS NOT A SPRINT
Even Mongi Msolly, president of the Association of State Hospitals, does not see the transformation of hospitals into joint-stock companies as a top priority. “It is one of the alternatives, but not the first. For some hospitals, it is premature,” he says, adding that the starting line is to find the reasons why hospitals are in debt. According to Michal Štofek, the state secretary of the Ministry of Health, the department has prepared several key tools for the central management of hospitals and central procurement, and plans to conduct an in-depth personnel and production audit, which should shed more light on how hospitals are managed today. These steps should lead to the financial stabilization of the sector.
This summer, the government had to approve 191 million euros for additional financing of state hospitals. If this did not happen, there would be a threat of further indebtedness, which is why Slovakia faced a lawsuit by the European Commission before the European Court of Justice for late payments by state hospitals. “The indebtedness of state hospitals will certainly not be stopped this year. But neither will the future announced at the Autumn ITAPA 2024 conference. However, he reminded that the debt should not grow any more. “The financing of state hospitals is not a sprint. Countries that are decades ahead of us still subsidize healthcare with a much larger amount than we do. We cannot look at it from a two-three-year perspective,” reminded Štofko. Any saving in hospitals has to start very early in order to see the financial savings over time. “The indebtedness of state hospitals will end when they have stable, sufficient funding and control over their costs. These two things must come together,” thinks Dajana Petríková, executive director of the Slovak Health Insurance Association. He states that state hospitals are also allocated funds based on merit – each hospital receives 75 percent of the allocation, all state hospitals compete for the remaining 25 percent of the 191 million euro package based on their performance and quality. “In short, we do not have enough funds in the system. We don’t lack millions, we lack billions. If, for example, Slovakia paid as much per patient as the Czech Republic, we would have to have 2 billion euros more in the budget annually.Petríková clarified at the conference.
PHARMACISTS: UNUSED POTENTIAL IN HEALTHCARE
Another area that can contribute to the relief of the system is the wider involvement of pharmacists. They currently have limited competences in Slovakia, which include the sale of medicines and basic advice. However, in many Western European countries, a model in which pharmacists play a much broader role in the health system is already in place. Vaccination directly in pharmacies, prescription of selected drugs or screening are common practices that increase the availability of health care. “Slovakia is ready to take a step in this direction, but it requires legislative changes, investments in the education of pharmacists and in technologies that would enable more effective cooperation between the individual components of the health system,” responded Marián Jánoš, CEO of Dr. Max, saying that he and the Minister of Health are planning to open a discussion on this topic. If the debate gets going – Marián Jánoš sees the realistic deadline for expanding the competences of pharmacists in 2026.
GR. Marán Jánoš DR. MAX
CONFIDENCE IN MEDICAL DOCTORS AND SCIENTISTS IS KEY
“The level of the state can be assessed according to how the infrastructure of key sectors – primarily health and education – is built. In Norway, institutions are very well built and the overall care for education, health and families is very high,” says Mária Dušinská, a Slovak scientist who has been living in Norway for 20 years and who until last year headed the Norwegian Institute for Air Research (NILU). This Nordic country should be the way to start building the healthcare sector. The health care system there is based on high-quality data, the country as such has the best preventable mortality and life expectancy figures in Europe, and it manages to maintain health professionals. “Doctors in the country are highly respected because the government itself attaches great importance to them. Health care is financed by the state,” stressed Mihaela Roxana Cimpan, scientist and professor at the Department of Clinical Dentistry, Faculty of Medicine, University of Bergen. She emphasized that great emphasis is placed on dental care and prevention in the country, children under the age of 24 have free care. Just for comparison, the government in Slovakia canceled the reimbursement of the costs of dental care in the form of a dental benefit to health insurance companies before the summer. Mihaela Roxana Cimpan also stated at the Autumn ITAPA 2024 conference that in Norway, thanks to technology, many citizens do not even have direct contact with a doctor. “Slovakia and Norway are very similar. Both in size and history. However, people there strongly trust the state institutions and have no problem fulfilling the regulations that the institutions give them. People trust the government because they know the government trusts them,” Mária Dušinská concluded at the conference.
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