IntoBalance 09/2008 (english)

Government of Slovak Republic has again discussed the creation of one state-owned health insurance company. Information about the fulfilling of the timetable of its implementing, does not state when the Ministry of Health Care could introduce the transformation law. The law which should have already been in force since May has not even been officially introduced by the ministry. When this will happen is not certain. According to the minister of health care Zuzana Zvolenská the law is ready, however, the date of proposing it is not determined yet because first it is necessary to resolve the question if financing. The tender for an advisor has not been announced yet as well. It should have already been finished until April. Ministry has already introduced its conditions and it should be announced after the disclosure of the law.

Pharmacists have for the first time announced a list of more than 170 pharmaceuticals which they have problem of providing them to the patients.  The list contains pharmaceuticals for serious diseases. The biggest part is composed of oncological pharmaceuticals, then pharmaceuticals for rheumatism and asthma, anemia and pharmaceuticals for treating HIV. The reason of this situation is not only the export of pharmaceuticals abroad but also the fact that they even do not reach the Slovak market. Ministry of Health Care refuses the problem of unavailability and blames the pharmacists for spreading of a hoax. Yet the pharmacists insist on the claim that the medications for patients are not available. Ministry of Health Care at the same time gave a fine for the first time in the amount of 10.000 euros because of unavailable medication and plans to continue with this. Currently it investigates the unavailability of four other pharmaceuticals.

The Ministry of Health has prepared document which sets crucial changes in health care until 2030. It counts with the reduction of beds in hospitals. Whereas the current number of them is approximately 34 000, within 17 years the figure should plummet to 19 000. The document was already passed by government. The aim of the ministry is to make a better use of acute hospital beds. Those are earmarked for patients whose health status is suddenly deteriorated yet they do not pertain to chronic patients. The ministry plans to reduce their number and change their structure. On the other hand the number of rehabilitation and nursery beds for long-term sick (chronic hospital beds) should be increased.

Financial group Penta has confirmed the intention to build the new hospital in Bratislava. It assumes that it can build it at lower cost than is the estimation of Ministry of Health. The hospital will be built instead of a 30 year unfinished building of Rázsochy. State wants to build the completely new hospital in the part of Bratislava called Patrónka next to the military hospital. The new facility will replace some hospitals which belong under teaching hospital and are in bad condition. The most mentioned are the hospitals located in Kramáre and at Mickiewiczova street. State wants to use the PPP model to build a new hospital, i.e. it will look for a partner who would build it. The ministry estimates that the new hospital with 775 beds will cost 250 million 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.

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.

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 %.

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