2.5 Planning

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 (see also section 2.7).

To guarantee accessibility of providers, a minimum network requirement is set by the government to influence capacity planning. This network is based on calculations of the minimum number of physicians’ posts in outpatient care and a minimum number of hospital beds for each of the eight self-governing regions. Minimum capacities are calculated per capita, but they do not consider specific health care needs of the population and the effective use of resources. Health insurance companies are responsible for maintaining the minimum network. Both selective contracting and the demand of the market motivate health care providers to adapt to changes in demand. The government can adapt the minimum network requirement and by doing so direct the planning of the health sector. Along with the regulation of minimum technical equipment and personnel requirements of hospitals, this represents a potentially effective tool for health policy planning.

The state, as the owner of the largest health care facilities, does not have a clear policy for long-term coordination and management. In 2002, the management of health care facilities by the Ministry of Health was unsustainable and this has led to decentralization of some health care facilities to self-governing regions or their partial transformation from contributory organizations into non-profitmaking organizations.

A lack of regulation is evident in long-term human resource planning. Decisions on the numbers of students and graduates of cost-free education at medical faculties are made by the university, funded by the educational sector and are not based on health sector needs (for more detailed information see section 2.8.3 Registration and planning of health workers). EU accession has strengthened the mobility of health professionals and has resulted in regional shortages in specialists. Expansion of the emergency medical service by requiring the service to employ anaesthesiologists has led to a decrease in the number of hospital-based anaesthesiologists. Rigid territorial planning of GPs until 2004, which made the profession unattractive for new entrants, in combination with the ageing of the workforce, has led to significant shortages in the sector.

The PHA has limited influence on health planning. It is responsible for the monitoring of hygiene standards in health care provision and can influence the scope of prevention covered by SHI. Despite the PHA having adopted several national programmes and national plans, these are not reflected in either the planning or purchasing of health care.

Self-governing regions are responsible for scheduling the 24/7 first aid medical services. If the in- or outpatient network of providers does not meet the minimum network requirements, regions together with the Ministry of Health cooperate to solve such situations. Cross-border capacity planning does not exist.