Slovakia spends less on healthcare than the EU average, yet it also holds the European record for the number of outpatient visits per capita. The core problem is not just money, but inefficiency: specialist gatekeeping doesn’t work, prevention is underestimated, and the patient journey is needlessly convoluted. Solutions are emerging in gatekeeping, digitalization, targeted prevention, and new care models.
Paradoxes of the system: little money, many examinations
In Slovakia, a lower share of GDP goes to healthcare than the European average, yet patients undergo roughly 11 outpatient examinations per year—one of the highest figures in the Union. Such a discrepancy suggests that we spend money inefficiently and processes don’t work. Consistent gatekeeping is missing from the system: the general practitioner should hold the "keys" to specialists and filter out unnecessary consultations.
In practice, however, a patient often requests a referral and goes to several specialists one after another, even when it isn’t necessary. A more refined second-opinion model is therefore being discussed: the basic examination is covered by the insurer, and the patient can transparently pay extra for an additional voluntary consultation. Above all, though, process optimization and better coordination between levels of care are crucial.
Prevention that saves lives: from ultrasound to genomes
Debates after the widely publicized death of a well-known figure showed how easy it is to blame the emergency department—yet diagnoses such as acute aortic dissection are exceptionally difficult there. The key is rather early detection of abdominal aortic aneurysm with a simple ultrasound. If the enlargement is found, it can be monitored and electively addressed upon reaching a threshold, which can prevent tragic outcomes.
Prevention, however, is not just about devices, but also about education and motivation. Genetics and precision medicine can identify groups at elevated risk that deserve more targeted oversight—it is not about blanket testing of everyone. Digital tools can ease the routine, often "boring" part of prevention, while the physician focuses on decisive moments. Meaningful indicators and clear patient pathways are prerequisites for prevention to stop being the system’s Cinderella.
New patient pathways: telemedicine, oncology centers, and community care in psychiatry
Telemedicine makes it possible to monitor, for example, patients with heart failure via a blood-pressure monitor, pulse oximeter, scale, or even analysis of a short video. Algorithms flag worsening conditions, and a timely phone call is often enough to sort out a misunderstanding in medication dosing and prevent hospitalization. Such interventions make sense, especially when they are grounded in analyses that pinpoint exactly where the system loses the most.
In oncology, comprehensive centers are emerging with multidisciplinary teams and a clear patient pathway from screening through treatment and research; faster communication, including SMS when results are positive, is meant to prevent delays. Psychiatry, meanwhile, is shifting toward community care as close as possible to the patient’s everyday environment: the recovery plan is set to add dozens of community day-care centers, which will free up clinics for more acute cases. Changes in education and the residency program can gradually address the shortage of specialists.
