HPI

At Slovakia are pre-operative assessments made about quarter million times per year. This examination should be easier for patients from now. The Ministry of Health plans to enable its performing from March by general practitioners, both for children and adults. So patients will no longer have to visit the internist. Currently, without visiting internist is impossible to be hospitalized. As explained by the main expert of Ministry of Health, for general practitioner is it possibility and not an obligation. Condition for providing this assessment is for example to have the ECG, which is not mandatory equipment for GP´s, however, many of general practitioners have it.

Debt of healthcare facilities to the Social insurance company grows even further this year. The end of January facilities owed on premiums € 89.7 million. Monthly their claims increased by more than 3.3 million. Accounts receivables of state-owned medical facilities have reached at the end of January this year more than 58 million euros. It is a monthly increase by nearly 2.7 million euros. Debt of transformed medical facilities was more than 31.6 million euros. Per month it increased by € 673,000. Social Insurance company register 21 healthcare facilities with the claims. Of these, five are state-owned and 16 are transformed healthcare facilities.

Salaries of employees of state-owned hospitals and specialized facilities will since the middle of January increase by four percent. The Association of state-owned hospitals and Slovak labor unions of health care and social services have agreed on the addendum to collective agreement of higher level from 2012. According to the data of Ministry of health, the other medical workers earned in teaching hospitals on average 783 euros, the average salary of nurses and delivery assistants was in these facilities 1,016 euros, physicians earned on average 2,500 euros. The increase in salaries will not take into account those workers whose salary was in years 2012 and 2013 increased on the basis of special laws. Addendum to collective agreement at the same time guarantees salaries to nurses at the level of the law about their salaries. Collective agreement including the addendum will be in force till 30th April 2014.

Ministry of health care has announced a tender on 74 licenses for operation of ambulance cars. The reason is that the current licenses are expiring. Last year the first two rounds took place. We are still waiting for the results of the second round. Because of the first round the chief of the resort Zuzana Zvolenská had to face an attempt for removal from the office by the parliament. The new licenses, for which the applicants can ask till 17th of March, should according to new legislation be in force for six years instead of current four years. Amended law about the providers of health care at the same time brought the obligation to submit together with the request for the issuing the permission also the statement about personal ensuring of operation of ambulance and the project of strategy and development of ambulances.

Thanks to statements from accounts of insured the health insurance companies are able to uncover claiming of fictive performances or prescriptions. General health insurance company (VšZP) has noted also a case, when the insured found in his personal account that he was hospitalized even though he was at that time abroad. According to the words of the spokesperson of VšZP Dana Gašparíková, the statement from the account was last year requested from approximately 25,000 insured of VšZP. The insured of Dôvera, according to their PR specialist Monika Šimúnová take advantage mainly of the electronic subsidiary in which they see besides other things their own statement from account. The access to it has 315,000 insured. Health insurance company Union received last year 335 written requests about the statement from account of insured. More than 15,000 other people have the option to access it by means of electronic services of insurance company.

According to the conclusion of the organization Transparency International Slovensko (TIS) which compared nine biggest procurers, one third of the state-owned hospitals was buying the electricity for a higher price than was necessary. TIS declares that three hospitals could have saved 450,000 euros yearly. At the same time they pointed out that Ministry of health, despite the plans, have not realized the central purchase of electricity. There was an estimated saving of 10 % from this step. Among the hospitals with high-priced electricity is Teaching hospital of Bratislava. Last year it purchased electricity by the form of negotiating without making it public. The price should be high also according to the amount of consumption. Stredoslovenský ústav srdcových a cievnych chorôb, which has compared to Teaching hospital in Bratislava consumption lower than one tenth, pays for 1 MWh by 12 euros less.

Medical facilities owed at the end of December 2013 on the social contributions to Social insurance company more than 86.3 million euros. That represents an increase of accounts receivables by more than 37.6 million euros. Accounts receivables to state-owned medical facilities reached at the end of December the level of almost 55.4 million euros. It is a monthly increase by more than 4.3 million euros. A rise of accounts receivables because of not paying is registered in a hospital in Banská Bystrica, also in hospitals in Bratislava, National transfusion service and Psychiatric hospital in Hronovce. According to minister of health Zuzana Zvolenská, the problematic are hospitals in Bratislava and Banská Bystrica. The debts of transformed facilities constituted 30.9 million euros.

Health insurance companies do not receive from the package of money collected on the health insurance contributions the same amount for every insured. It depends on the factors of age, gender and economic category, and if the patient has some of the serious diagnosis which requires administering of expensive pharmaceuticals. The money is reallocated among health insurance companies by means of cost risk index for health care. According to health insurance company Dôvera the preciseness of estimation of the amount of the cost according to the cost risk index differs from the real cost by about 20 %. Until the last year was this estimation according to health insurance company much less precise, it was about 4 %.

Since the next year the state will pay less for its insured. It will be historically the lowest contribution, which will be at the level of 4 % out of the average wage from 2 years ago. The insured of the state are the most expensive patients. Among insured of the state are children, retirees, unemployed or mothers on the maternity leave. Together they compose more than 3 million people. The contributions of the state for its insured are declining from year to year. Whereas in 2010 it was 4.78 % out of average wage, this year it was only 4.25 %. It was monthly per one insured 33.44 euros, from the new year the state will pay 32.20 euros.

Contracting the physicians – specialist by the state-owned General health insurance company (VšZP) should be changed the next year. The biggest health insurance company will prolong their contracts until the end of 2014; however, the price terms will be in force only until March. According to the director of health insurance company Marcel Forai there is no plan of cancelling the current contracts with physicians yet. There will be just new settings for the criteria for contracting new physicians and new rules for ordering the health care. The goal is a fairer remuneration of specialists on the basis of more transparent criteria. The state insurance company wants to contract the physicians according to the amount of working hours and not according to number of physicians. As Forai pointed out, e.g. in the Bratislava region the VšZP has contracted 27 endocrinologists; however, from the point of view of working hours it is only 23 physicians.