Prevention in Slovakia does not have a master, it is partly covered by the Public Health Office (ÚVZ) and the Ministry of Health. However, it does not have a very tangible effect. Tomas Szalay (SaS), director of the Health Department of the Bratislava Self-Governing Region (BSK), said this during a panel discussion at the third annual conference of the Healthcare Daily titled Economics of Prevention. According to him, local governments could help in the future.
Szalay, a doctor and shadow health minister of the political party Sloboda a solidarita (Freedom and Solidarity), pointed out at the conference that prevention is not coordinated at all in the Slovak health care system. „Prevention in Slovakia does not have a master. Officially, it is called health promotion, which falls under both the Public Health Office and the Ministry of Health. However, neither of these institutions wants it very much because there is no money for it. They have no money to pay people to create a prevention strategy,“ Szalay stressed.
He said local governments could take over the country’s prevention strategy. „They are closer to patients and have a higher level of credibility than the Ministry of Health. In addition, they could bring together different sources of information from insurance companies, the health authority and target the determinants of health. For example, we could identify doctors who do not vaccinate because they are opposed to vaccination. We would be able to identify them and not send patients there for vaccination,“ said the head of the BSK health department, giving an example.
Insurers want to save money, not improve prevention
But health insurers are also promoting prevention. They also offer their clients certain benefits beyond the law. These include, for example, allowances for dentists, glasses or other financial rewards. But Szalay pointed out that these benefits have become too costly for insurance companies, so they have started to regulate them more. Patients therefore only get them if they have regular preventive check-ups. This is not just a check-up with a general practitioner, but also with a gynaecologist, dentist and other specialists, for example.
According to Szalay, however, insurance companies are not primarily concerned with improving the state of prevention in Slovakia. „I think that the aim of insurance companies is not to increase participation in preventive check-ups, but to save on unpaid benefits. Because a lot of people don’t end up going for preventive check-ups,“ he explained. Although the conditionality eventually increased the number of people going for regular preventive check-ups, it also reduced the uptake of benefits by insurers, according to Szalay.
He bases his assertion about insurance companies on practical experience. In the Bratislava region, after the vaccination against covid, vaccination against other diseases was also launched. „But we came across the fact that insurance companies did not want to reimburse even just the act of vaccination, if it is not a capitated patient of a given vaccinator. Logically, this cannot be met as only one doctor would vaccinate all the patients. The insurance companies simply didn’t want to pay for it. That’s why I think insurance companies are not primarily concerned with high vaccination rates and preventive screenings, otherwise they would be willing to pay for it,“ Szalay said.
Slovak healthcare is in collapse
Asked who should communicate about prevention to the public and do a campaign to highlight its importance, Szsalay said the Health Ministry can do a general campaign, but insurance companies and health care providers must do a targeted one. The ministry is supposed to set the direction, but he said specific actions should be done by the sector.
Szalay explained that everyone in the Slovak healthcare system should be given a target role. In his words, this concerns doctors, clinics, health insurance companies, but also patients. However, everything should be regulated by the Ministry of Health, which will define the tasks. „If the ministry identifies as a priority that some preventive programmes need to be improved, it will give this task to the insurance companies in the first place. For them, the fulfilment of this task should then be a condition for the payment of profit. This means that it will be the task of the insurance company to delegate the fulfilment of the ministry’s task to the providers and patients,“ he explained.
However, he does not assess the current situation of the Slovak healthcare sector positively. According to him, the Slovak healthcare sector is in collapse. The country has many plans and strategies, but he said they lack funding and milestones. He stressed that these are key parameters.
As an example of the poor state of health care, he recalled last year’s analysis of the Supreme Audit Office of the Slovak Republic. It focused on the strategic documents of the Slovak health sector. „They wanted to get them from the ministry, but they found that the ministry did not know what strategic documents they had. So the auditors had to look them up and analyse them. In the end, they found that of the 11 documents analysed, only two mentioned some marginal milestones and nowhere was funding included,“ the head of the health department at BSK said.
Photo by Radek Čepelák
We would like to thank the General Health Insurance Company, National Sports Agency, RBP, Health Insurance Company of the Ministry of Interior of the Czech Republic, Military Health Insurance Company, EUC Medical Group and Sprinx for their support of the conference.