IntoBalance 07/2008 (english)

Private VHI is part of the commercial insurance system. So far, private VHI plays only a marginal role due to the broad benefit package and low official cost-sharing requirements. According to the National Bank of Slovakia, total VHI premiums are approximately €1 million (in 2009). Thus they account for only 0.02% of total health expenditure and 0.2% of overall non-life insurance premiums.

The objectives of the current Slovak health care system originate from the Bismarck and Semashko health system models. Its primary purpose is to ensure universality, equity and free access to health services at the point of delivery; however, these objectives are met only formally in practice (for example, patients make informal payments to doctors) and any potential changes (for example introduction of user fees) are not welcomed by the population due to cultural patterns and conventions.

Due to the 2004 health reform, the Kakwani index dropped • slightly, from 0.074 (2002) to 0.045 (2005). Although the progressivity of direct taxes and SHI has increased, at the same time the regressivity of indirect taxes and direct payments has increased.

IMF study (2007) concludes that Slovakia combines relatively low health spending with relatively poor health outcomes. Inefficiencies in the Slovak health system occur mostly in the process of transforming intermediate health resources into health outcomes. The IMF study sees two reasons for this. First, this is due to inertia – for instance, hospital structures may still reflect old standards and a significant proportion of current health workers were educated in the pre- and early transition period. Second, high cost–effectiveness in Slovakia reflects relatively low prices for labour and other inputs for health services. As a result, despite spending levels, real resources in the health sector are relatively high.

The Slovak health system has historically been characterized by high utilization of health care services. Although the introduction of user fees in 2003 decreased the number of contacts, the visiting rate remained high. After reducing and partly abolishing the user fees in 2006, the number returned to 2002 levels by 2007. As a heritage from the past, where universality, access and free health care was the main agenda, Slovak people enjoy a dense network of providers, both in outpatient and inpatient care.

The considerable improvement in the overall health status of the Slovak population over the past 20 years cannot be explained by economic progress and higher spending on health care alone. The second cause of the increase in life expectancy is changes in behaviour. Slovakians increasingly adopt healthier lifestyles, exercise more and eat more healthily. A third, very important factor in the gains in life expectancy since 1990 is the introduction of new diagnostic technologies, new treatment methods and the application of the latest evidence.

The HiT profiles are produced by country experts in collaboration with the Observatory’s research directors and staff. The profiles are based on a template that, revised periodically, provides detailed guidelines and specific questions, definitions, suggestions for data sources and examples needed to compile HiTs.

This consists of three stages. Initially, the text of the HiT is checked, reviewed and approved by the series editors of the European Observatory. The HiT is then sent for review to two independent academic experts and their comments and amendments are incorporated into the text, and modifications are made accordingly. The text is then submitted to the relevant ministry of health, or appropriate authority, and policy-makers within those bodies are restricted to checking for factual errors within the HiT.