IntoBalance 09/2008 (english)

DRG system, more transparent and equitable system of hospital payments, should work in 2016. Since April the Healthcare Surveillance Authority will start to train people. Training of nearly 3.200 people wants to catch by the end of next year. Trainings will cost more than seven million euros and should be paid mainly from EU funds. Eight people have been already trained in Germany, in a country whose DRG model we assume. The model will cost 1.4 million euros. The introduction of the new system is perceived positively by several hospitals and health insurance companies.

Materials for teaching health professionals who will be responsible for the launch of a new system of financing hospitals in practice are ready. However, the legislation is still lacking. Without it, according to the President of Healthcare Surveillance Authority Monika Pažinková, it cannot start.

Debt of medical facilities on unpaid premiums to the Social Insurance Company reached at the end of February 55.1 million euros. Compared to the end of 2012, there was an increase in receivables of € 6.4 million. Debts of facilities in the scope of Ministry of Health represented at end of the February more than 56.2 per cent of total assets, i.e. 31 million euros. Compared to January, the debts increased by more than 2.5 million euros. Transformed medical facilities have debt of € 24.1 million. Compared with the previous month, receivables of these medical facilities increased by almost 700.000 euros.

Staff members of hospital who owe to Social Insurance Company on outstanding contributions do not have to be worried. According to spokesman of Social Insurance Company, they are entitled to a benefit from Social Security even if the employer unpaid the premiums.

Prime Minister Robert Fico admitted that one insurance company does not have to be in January 2014, as the government planned. Minister Zuzana Zvolenska says that the planned date of one insurance company is still real. The plan of project is written that from May will be valid a new Act of transformation and by the end of this month will be finished the public procurement on advisor for the project. However, Ministry has not started the selection procedure and has not introduced the proposal of new law. Approval of new Act takes about three to four months. Ministry of Health Zuzana Zvolenska promised that this deadline will not be shortened. Submission of an Act of transformation and public procurement on advisor to the Ministry is expected in the coming days. When exactly it will be Ministry did not say.

The issue of overtimes of doctors in hospitals remains unresolved. Trade unionists are asking for comprehensive solution. The proposal, they offer, however, according to the Minister of Health Zuzana Zvolenska, does not solve anything. There is no agreement; however, patients should not be endangered. Both sides, though they have not found a common solution of overtime issue, confirmed that doctors’ services are secured for now. Medical Trade Union justifies the request for solution of overtime issue by the effort of cleaning the chaos in the service schedules. Unions asked for determination of maximum overtimes for physician per month.

Health insurance companies will return for the fourth quarter of 2012 hundreds of thousands euros for surcharges for thousands of disabled and retired patients. Policyholders will receive the money automatically to the account, so there is no need to apply for them. General Health Insurance Company will send back surcharges for pharmaceuticals to 23.517 policyholders, in amount € 448.206. Health Insurance company Dôvera will send back surcharges for pharmaceuticals to 5.886 policyholders, in total amount of 112.213 euros. Union Health Insurance Company will return to 1.500 policyholders the payments in total amount of more than € 30.600.

Hospitals, which will do more surgery, will get more money. For each patient after surgery in 18 selected surgical disciplines should get hundred euros extra. This is new philosophy of funding by General Health Insurance Company (VšZP) which should be valid from April this year. This new way of funding is relevant for all university, teaching and general hospitals. The aim of this measure is to decrease the waiting times. State General Health Insurance Company also wants to check the evidence for waiting lists in hospitals. If it finds that some patients are preferred or there is mess in evidence, hospital receives a fine. If hospital fails to dispose patient from evidence, at first notify the provider and after repeated warnings, the hospital may not gets paid for the surgery or gets paid only part of it.

According to analyses of Transparency International Slovakia (TIS), Ministry of Health decides which drugs will be covered by health insurance not always in accordance with applicable regulations. TIS analysis points out that half of the applications for new drugs in the past year have not been settled up within the statutory period of six months; the ministry generally lacked expert opinions, and never once was assessing the cost-effectiveness and impact on public finances, despite the fact that the law requires it. Health insurance companies paid annually on drugs 850 million euros, what represents about a third of the total cost on health care from public sources. The analysis examined the categorization of drugs for about one year.

Pokus

Debt in health care (measured as overdue liabilities) reached at the end of last year € 213 million. Liabilities of state facilities amounted 141.7 million euros, representing an increase of 72.3 million. The largest part of the debt and generate teaching and university hospitals, with the exception of hospital in Nitra. Health care facilities transformed into joint stock companies, which do not show any overdue liabilities. According to estimation by Health Policy Institute (HPI), at the end of the year 2013 may debt exceed amount of 300 million. €. From previous experience, HPI consider this limit from the view of suppliers’ patience as critical. Therefore HPI assume that in 2014 will be needed another debt elimination of hospitals.

If and when will be the one state insurance company, is uncertain. Since the beginning of May should came into force Act, which is necessary for its implementation. However, Ministry of Health has not yet given the Act to the commentary proceeding. "It will be soon," claims Minister of Health Zuzana Zvolenska for several weeks. According to the original schedule, approved by the Government, this Act should have already become effective from 1st May. From December to April the state should chose a consultant who can valuate the insurance companies. The choosing process even did not begin. Why is it so, the Ministry does not say. Although Zvolenska plan is late, she promises that the Act will be not accepted by accelerated procedure. Dates are according to the spokeswoman only preliminary and final date of introduction of one state insurance company will be right on time.