Sociálna poisťovňa has taken on a sensitive topic: the abuse of temporary incapacity for work and leniency in granting disability. Thanks to better use of data and cooperation with healthcare institutions, the number of sick leave cases has fallen by approximately 15,000 per month, which could bring savings in the tens of millions of euros. The next step is assessment based on functional status, not just the diagnosis.
A shift in approach: eZdravie and rigorous oversight
The turning point came with the application of a rule in force since 2018: healthcare data belong in the eZdravie system, and medical assessors gained access to them. In cooperation with NCZI, health insurers and academic institutions, the insurer began comparing documentation and deliberately reviewing long or non-standard sick leave cases. Already today the result is about 15,000 fewer sick leave cases per month compared to the baseline 150,000, and at the current trend this may mean roughly 100 million euros a year in direct savings. Indirect effects also come from people returning to work and a lower burden on health insurers for procedures related to sick leave.
Oversight over providers has also been strengthened: reviewing physicians monitor exceptionally high numbers of sick leave cases at some practices, and in cases of an obvious discrepancy the insurer cooperates with VšZP, self-governing regions and professional chambers. Extremes have also appeared – the cancellation of dozens of sick leave cases by one doctor, or hundreds of sick leave cases for employees of one company over the course of two days, and there were even “curious” reasons such as sick leave at an entry medical examination or an indeterminate “change in life situation.” The goal is to protect honest patients and limit abuse, not to punish short and justified sick leave. By the way, company benefits such as 100% income compensation usually apply to the first two weeks; the insurer mainly deals with long-term sick leave.
Disability: from diagnosis to functional status
The question of sustainability also applies to disability pensions, of which there are around 250,000 recipients in Slovakia – in absolute numbers almost as many as in the Czech Republic, which is twice as large, while Austria is relatively lower. Sociálna poisťovňa is therefore shifting the focus from diagnosis to functional status: not “what a person cannot do,” but “what they can do.” Verifying data in electronic documentation has already led to applications being rejected when the documents from the applicant did not correspond to the records in eZdravie. The first changes will affect psychiatry, where accreditation of facilities for independent assessment is planned, and the aim is to reliably separate genuine need from abuse – while maintaining maximum support for those who truly need help.
