Although the new government has in its program manifesto agreed with the health care reform of Rudolf Zajac (Minister of Health in 2002 – 2006), but it was not able to overstep the fear from private ownership in health care.
When we are comparing the document Reform government, which HPI announced before election and the Program manifesto of the Government (PMG) we find out, that in PMG has from the total number by us suggested 52 measures appeared 25, that is almost half. At most is missing more resolute shift to decreasing of engagement of state in health insurance and hospital facilities.
The key measure for remedying the damages after Fico’s government is enabling the generation of profit for health insurance companies by precisely defined conditions. The government adds to its liability, that the process will run in order not to worsen the position of the state in continuing arguments for protecting investments. The prohibition of generation of profit passed by Fico’s government actually caused, that stockholders of two insurance companies (Dôvera, Union) sue Slovak Republic in international arbitrage.
Second very important measure is realization of transformation of hospitals to stock companies. And not only the state contributory organizations, but also non-profit organizations. Transformation of hospitals is a good step towards their balanced management and its cancelling in 2007 didn’t contribute to economic responsibility of state hospitals. Their debt during the Fico’s government grew to 271 mil. €.
Third exceptionally important measure is repeated returning of independency to Health Care Surveillance Authority (HCSA). Changes passed by government of Robert Fico made from HCSA institution dependent on minister, which has mirrored in inconsistent decisions of the office. We will only remind the failure of previous management of office in case EZP, wrongly sanctioned Dôvera health insurance company or the disregard towards negative development of financial situation in VŠZP.
Fourth important step is the abolition of fixed minimal network, which from 2008 provided to state hospitals inadequate advantages at the expense of other providers.
Government has avoided ambitions to raise participation of citizens by reintroduction of user fees. Their introduction together with upper limit on user charges and the possibility of choosing either the exchange receipt or a fee would strengthen economic awareness of citizens and at the same time would not threaten socially weaker groups. Those could still go to physician for free, but with an obligation of exchange receipt. The rest, without exchange receipt would pay to specialist.
Government also eschewed the strengthening of private sector in health care. To program declaration of government wasn’t incorporated also the division od VŠZP into 3 to 4 parts and subsequent privatization of these parts in an international tender and also the shift in privatization of state hospitals. And right VŠZP and state hospitals cause to state not small financial problems.
Third missing area is the absence of an independent HTA agency, which would evaluate clinical effectiveness of diagnostical and medical interventions and at certain circumstances it could serve as an independent authority for assessing width and depth of the range of health care refunded by public health insurance.