7.5 Contribution of the health system to health improvement

In spite of the past paradigm of care being universal, accessible and free at the point of delivery, Slovakia witnessed 30 years of stagnation in life expectancy from the 1960s. Life expectancy for men decreased by 1.65 years in the period 1967–1990, while for women slight progress (1.61 years) was observed in the same period. After 1989, strong gains in life expectancy were made. Life expectancy for men increased by 3.86 years and for women by 2.65 years in the period 1990–2007. Despite this progress, the gap between Slovakia and the EU15 is not closing (see Fig. 7.5).

Fig. 7.5: Life expectancy in Slovakia and EU15 average

According to the WHO World Health Report 2000, people in richer countries live longer without disabilities than people in poorer countries (WHO, 2000). This is also accompanied by lower variability of outcomes in richer than poorer countries. Slovakia does not provide an exception. According to OECD data, life expectancy in Slovakia corresponds to the recent economic development in Slovakia (Fig. 7.6). The rationale behind this is that countries with a higher GDP spend more on health than poorer countries. With a growing economy, the expenditure on health is proportionally increasing (Fig. 7.7).

The main differences are in the structure of health care spending. Slovakia spends a much higher percentage on drugs than OECD countries did when they were at Slovakia’s economic level (Fig. 7.8). The higher spending levels on drugs crowd out inpatient and outpatient expenditures, which are both much lower than in the Czech Republic and Hungary (Fig. 7.9 and 7.10)

Fig. 7.6: GDP and life expectancy, 1960–2007

Fig. 7.7: GDP and expenditure on health as % of GDP, 1960–2007

Fig. 7.8: GDP and pharmaceutical expenditure as % of GDP, 1960–2007

Fig. 7.9: GDP and inpatient expenditure as % of GDP, 1960–2007

Fig. 7.10: GDP and outpatient expenditure as % of GDP, 1960–2007

The considerable improvement in the overall health status of the Slovak population over the past 20 years cannot be explained by economic progress and higher spending on health care alone. The second cause of the increase in life expectancy is changes in behaviour. Slovakians increasingly adopt healthier lifestyles, exercise more and eat more healthily (Publicis Knut, 1999, 2003, and 2007). A third, very important factor in the gains in life expectancy since 1990 is the introduction of new diagnostic technologies, new treatment methods and the application of the latest evidence.