IntoBalance 09/2008 (english)

Slovakia lacks a clear health information policy and, as a  consequence, good quality information. The e-health project is mainly focused on the technical structure rather than content and functionality from the point of view of health policy decision-makers. As a result of selective contracting and their purchasing role, health insurance companies play a key role in the planning process.

Since 2008, all employers must offer an occupational health service for employees working in high-risk environments. An occupational health service is a professional counselling service for employers in occupational health protection.

Slovakia lacks a long-term strategic planning policy. The state, through its regulatory competences, has influence over health care purchasing, but the information necessary for effective regulation of capacities and allocation of resources is neither collected nor evaluated.

State administration was decentralized in 1990 by re-establishing local self-government at the level of the municipalities. In 2002, self-government was also introduced at the regional level by establishing the self-governing regions. Decentralization of competences and finances, and political decentralization followed. Decentralization in the health sector focused on partial delegation of state power to the self-governing regions.

Slovakia is a parliamentary democracy with separation of legislative, judicial and executive powers. According to the 2008 Freedom House report, Slovakia is a free country (listed in the “free” category). The Economist Intelligence Unit rated Slovakia in 2008 as a flawed democracy. Transparency International has been critical of Slovakia in terms of insufficient government efforts to deal with corruption.

Compared to other countries, the number of physicians and nurses per capita was similar to those of the EU15 until 2001. After 2001, Slovakia witnessed a continuous fall in the number of physicians and nurses in relation to the population, although their numbers remain above the EU12 average. These changes are closely linked with the migration of doctors and nurses abroad and the restructuring of health care facilities. National data show that, since 2006, the health workforce has started to increase again. Yet the ageing workforce combined with migration of health care workers may reinforce the shortage of health care workers. Although exact data on migration are lacking, this is considered common knowledge.

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.