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2. Organization and governance
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1.4 Health status |
Introduction – Organization – Financing – Resources – Provision – Reforms – Assessment – Conclusions – Appendices | NEXT >>
2.1 Overview of the health system |
- 2.1 Overview of the health system
- 2.2 Historical background
- 2.3 Organization
- 2.4 Decentralization and centralization
- 2.5 Planning
- 2.6 Intersectorality
- 2.7 Health information management
- 2.8 Regulation
- 2.9 Patient empowerment
The health care system in Slovakia is based on universal coverage, compulsory health insurance, a basic benefit package and a competitive insurance model with selective contracting and flexible pricing. Health care, with exceptions, is provided to insured individuals for free as benefits-in-kind (paid for by a third party). After fulfilling certain explicit criteria, there are no barriers to entry to the health care provision and health insurance markets. Based on the quality of their services, health insurance companies compete for insured individuals. Health care purchasing creates room for competition.
The tradition of the Bismarck system of social and health insurance dates back to the 19th century. The territory of Slovakia was a Hungarian part of the Austro-Hungarian Empire until 1918. Hungary was one of the first European countries to introduce compulsory health insurance in 1891.
Health policy results from the interplay between the Ministry of Health (legislator), the health insurance companies (purchaser) and the HCSA (supervisor). Health policy is influenced by providers, as well as professional organizations. Different ownership forms exist among providers and health insurance companies. One of the main owners is the state, which owns the largest hospitals and the largest health insurance company.
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 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.
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 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.
The Parliament as a legislative branch passes acts. As the executive branch, the government and the Ministry of Health enact secondary legislation (regulations, decrees, rulings, measures, guidelines) with varying scope and different means of enforcement. The HCSA is responsible for monitoring health insurance, health care purchasing and health care providers, and also enforces the regulatory framework. The role of health insurance companies in system regulation results from their competences as purchasers of health care services. This includes maintaining the conditions of selective contracting and flexible pricing.
Advocating patient rights has become a major topic in Slovak health care. To improve the situation, increasing awareness, monitoring and education are important. Currently (2010) there is still no organization to take this forward. Consumer and patient organizations show very different degrees of activity, which is due to their dependence on dedicated individuals and (unstable) external financial funding. Success in advocating for patient rights is often hindered due to the unclear boundaries between the health sector and the social sector, which are both the domain of patient organizations.
