National report Slovakia

National Report, Slovakia, spring 2013

1. Unitarisation of health insurance system.

The big chalenge in Slovakia is now the preparation to change the plurality health insurance system to one insurance found at basic health insurance.The new health insurance system started in Slovakia from 1993, when founded the National Insurance Found, in 1994 was devided to Social Insurance Found an National Health Insurance Found. From 1995 we started the new health insurance low, with possibilities to found health insurance founds by employers, municipialities etc. In 1999 we have in Slovakia 14 health insurance founds, but the strangest position still has state General Health Insurance Found, with more than 3.5 milions members. /Slovakia has 5.5 milion citizens/. The situation at the Slovakian health insurance market actually changed, some insurance founds went to bancrupcy, the others to melt together. In today situation  we have 3 health insurance founds, there are the joint stock companies: The General Health Insurance Found  / 3.3 milion members, owner the government/ , Health insurance found Dôvera / 1.5 milion members, the owner is the Private Equity found Penta/, and Health Insurance Found Union /700.000 members, the owner is the Achmea from Holland/. The start of unitary health insurance system in Slovakia is planned from 1.1.2014. Prime Minister Robert Fico admitted that one insurance company does not have to be in January 2014, as the government planned. Minister Zuzana Zvolenska says that the planned date of one insurance company is still real. The plan of project is written that from May will be valid a new Act of transformation and by the end of this month will be finished the public procurement on advisor for the project. However, Ministry has not started the selection procedure and has not introduced the proposal of new law. Approval of new Act takes about three to four months. Ministry of Health Zuzana Zvolenska promised that this deadline will not be shortened. Submission of an Act of transformation and public procurement on advisor to the Ministry is expected in the coming days.

2. E-health

Government has approved the proposal of Act on National Health Information System (NHIS) made by the Ministry of Health. As can be seen from the material, policyholders should get a health insurance card with an electronic chip until the end of 2015. Electronization of Health care should cost this year 1.2 million euros. Money should be used to cover the operator's license of eHealth, support of legislative team and operating costs for the NHIS. Operation of the NHIS will require addition € 3.9 million this year. In the next year it will be 9.3 million and in 2015 and 2016 it should be € 9.5 million. Ministry of Health Zuzana Zvolenska said that they want to re-examine whether it is possible to somehow combine the issue of identity cards with an electronic chip and access to eHealth. ID cards could be merging with health insurance cards in the future. About this option should negotiate ministries of Health, Finance and Interior.

3. Regulation of access to specialists

There will be no more direct access to specialists. Patients will have to visit GP for recommendation.

4. Criminalisation of physicians ?

The Ministry of Health wanted to enforce that the physicians, nurses and other health professionals had to start work during the state of emergency. According to the Act, the doctors and nurses could be threatening not only by a fine to € 3300, but also by the prison. If somebody avoids going to work, could be threatening by to two years in prison. If there will be severe damage to the health of the patient or patient will die, the penalty may be extended to five years. The proposal did not like even the largest medical organization bringing together trade unionists in Europe - the European Federation of Salaried Doctors (FEMS). The proposal was finally withdrawn. Amendment to Act on providers has a milder version, which allows introducing a two-three shift service after consultation with the union. Amendment should come into force from September 2013.

5. Drugs reimbursement

 Price of pharmaceuticals in Slovakia will be not higher than the average of three lowest prices in the European Union. This principle is also related to medical devices and dietary supplements. This stems from an amendment to the Act on pharmaceuticals signed by President Ivan Gašparovič. Currently, the maximum price can not exceed the second lowest price in the European Union. Before that, prices were set by comparison of six lowest prices in Union. The aim of the amendment is introduction of more equitable method of pricing of pharmaceuticals considering prices of other Member States and exchange rate changes.

It is the real risk to re-export of drugs.