3.4 Out-of-pocket payments

Thursday, 05. May 2011, 0:48


3.3 Overview of the statutory financing system


3.5 Voluntary Health Insurance (VHI)

According to the Statistical Office of the Slovak Republic, an average Slovak spends more than €200 annually on health out of pocket (Table 3.7). In 2009, out-of-pocket expenditure amounted to 1.8% of GDP. As share of total health expenditure, Slovaks spent 23.6% on health out of pocket in 2009, a significant rise from 2002 when it was only 11.7%. The main reasons for increasing out-ofpocket expenditure are rising co-payments on drugs, higher spending on OTC drugs, increased use of private providers by patients, and increase of different administrative fees and informal payments in the state sector.

Table 3.7: Private expenditure according to national data

Out-of-pocket payments in Slovakia mainly consist of (1) user fees for prescriptions and various health services; (2) co-payments for prescription pharmaceuticals and spa visits; and (3) direct payments for OTC pharmaceuticals, above-standard care, preferential treatment and care not covered by SHI (see Tables 3.8 and 3.9).

3.4.1 Cost-sharing (user charges)

In 2003, measures were introduced to stabilize the financing system. One of the measures was the introduction of an elaborate system of user fees for a doctor’s visit (€0.66), one day of hospital stay (€1.66; plus €3.32 for accompanying people), a prescription (€0.66), emergency care (€1.99), ambulance transport (€0.07/km) as well as for food and accommodation in spas (€4.98–7.30 per day). Following the change of government in 2006, user fees for a doctor’s visit and one day of hospital stay were abolished. The fee for a prescription was reduced to €0.17, which is paid in addition to co-payments where the price of the drug is above the reference price.

A full overview is provided in Table 3.8. User fees are analysed in more detail in section 6.3.1 Introduction and subsequent abolition of user fees.

Table 3.8: Cost-sharing in the health care system, 2010

3.4.2 Direct payments

Direct payments are payments made at the point of use for goods or services that are not covered by SHI. In Slovakia, these mainly consist of OTCs and non-SHI services, as well as preferential appointments. A full overview is provided in Table 3.9.

Table 3.9: Direct payments in the health care system, 2010