The chairman of the Office for Supervision of Health Care and former minister Michal Palkovič says that Slovakia urgently needs a reform of the hospital network, which must be linked to DRG-based payments. He explains options for the Bratislava hospital, his view on insurer financing, and tools that can shorten waiting times and reduce duplication. The office's priorities also include stabilizing forensic medicine and pathology services, digitization, and the sensible use of artificial intelligence.
Hospital network reform: between reality and plans
Palkovič emphasizes that the reorganization of hospitals needs to be brought to completion, although he does not consider its current development ideal. It is a milestone of the Recovery Plan, but the key is to link it to DRG, which is already running, including the reimbursement component, and can settle contentious situations. Decisions about specific hospitals (for example, Brezno), he says, depend on meeting the conditions and the actual scope of services, and some precedents from the past are not suitable for the future.
In Bratislava, several locations were considered, but the most practical appears to be a solution in Ružinov following the example of Banská Bystrica – north and south towers within the existing complex. The advantage is the existing transport and technical infrastructure, including the planned southern transport hub, which reduces costs compared to a "greenfield" site. A decision must be made quickly, as construction will take years and only then will it be possible to systematically wind down older sites (for example, Kramáre); the timeline is estimated at 8 to 10 years. A condition is to have a detailed "Bratislava axis" – that is, a plan of transfers and capacities.
Money and the regulation of insurers
According to Palkovič, the 1% profit cap for insurers is not the main problem today, because the market has not shown significant profits for years; more important is whether the system is set up correctly. The Office wants to evaluate the redistribution decree for 2023 by the end of April and consider adjustments for 2024, since regulation can also have undesirable effects on competition. Regarding the differences between VšZP and private insurers, he adds that it is an effect of the split of inpatient care – an amount around 60 to 64 million euros was cited in 2023, but the new "split" towards 62 % may soften the problem. Account balances should not be confused with the financial result; insurers did not pay dividends, and when setting the rules, their liquidity must also be carefully safeguarded.
Urgent care, digital tools, and the Office's priorities
Palkovič sees the future of outpatient urgent care in bringing it closer to hospital emergency departments, with unified triage and clear patient guidance. An app for basic triage of children can help parents orient themselves and estimate waiting times, but it will not solve the problem on its own – it must be linked to the individual sites and supplemented with clear education that often there is no need to go anywhere. Tools for professionals are also key: sharing laboratory results would limit duplicate tests, but it requires a legislative change.
According to him, the eLab project depends on an amendment to Act 153; otherwise, the enforceability of common rules is lacking. DRG is successful, but it will progress best through cooperation between the ministry's and the Office's teams. Among the immediate priorities of the ÚDZS are the relocation and temporary securing of the forensic medicine and pathology facility in Banská Bystrica in cooperation with Lučenec, and also the ePR project, which removes paperwork in the area of deaths. The Office also plans to conduct targeted checks on the use of purchased care, for example in hospices, rehabilitation, and palliative care. Palkovič believes in artificial intelligence in diagnostics, especially in pathology; the "AI vs. doctor" match, in his view, will end in a draw.
