The range of benefits available to individuals covered by SHI in Slovakia is broad. The SHI system is financed through a combination of contributions from the economically active population and state contributions on behalf of the non-economically active population (“state-insured”). Contributions are collected and administered by health insurance companies. To alleviate the financial burden on health insurance companies with a higher-risk portfolio and to reduce the potential for risk selection, SHI contributions are redistributed among the health insurance companies using a risk adjustment scheme. Health care purchasing is based on selective contracting.
The main sources of revenue in the health system are contributions paid to the health insurance companies under the SHI system. These include contributions by (1) employees and employers, (2) self-employed people, (3) voluntarily unemployed, and (4) “state-insured”. The latter term is used for the significant group of mostly economically inactive people for whom the state pays contributions (approximately two-thirds of the population and one-third of total resources from contributions). Payments to providers are subject to a contract that determines the amount of payments, the type and quality of services, and the payment system. Furthermore, the health insurance companies fund the HCSA in proportion to their revenue.
In 2009, total health expenditure as share of GDP was 7.6% according to national sources. This high GDP share was rather exceptional. Before 2009, the share was around 6.5% of GDP for three consecutive years. Slovak health insurance companies spend a relatively high share of their revenue on pharmaceuticals. Pharmaceutical expenditure amounts to 30% of expenditures by health insurance companies – compared to 7% on primary care, 11% on ambulatory secondary care and 27% on inpatient care.