Slovak healthcare is entering a year in which consolidation is expected and there is less room to maneuver than usual. The budget is growing, but the traditional “safety nets” are limited and the pressure to save will be higher. If the opportunity is used wisely, the year could also be a turning point.
Why this year will be different in healthcare
Although spending is formally growing by about 5 %, it is one of the lowest increases of the past decade. Most of it will be “eaten up” by inflation, wages, and an aging population, leaving minimal room for development measures. In addition, strict spending limits apply, which practically preclude the traditional mid-year top-ups via the state-insured.
Other reserves the sector relied on in the past are weakening. Expected contributions from the economically active will not surprise significantly on the upside, insurers have low cash reserves, and any freed-up resources may be swallowed by the dispute with the European Commission over the settlement of state hospitals’ liabilities. In other words, if more is spent somewhere, this time there will be no one to plug the gap.
Where to look for savings and what the risks are
Budget documents mention a savings package, but the exact amount is not entirely consistent (roughly 260 to 419 million euros). Part is to come from hospitals, including a gradual strengthening of the central management of state facilities. In pharmaceuticals, the plan counts on greater use of generics and biosimilar medicines and on adjustments to categorization; central procurement of medical supplies and a review of reimbursements are also being considered.
These are sensitive interventions with great potential but also a high degree of risk. History shows that savings targets have never been met 100%; the best year achieved roughly three quarters of plans. This year is more challenging in that failure will quickly translate into losses for insurers and providers – or directly into the availability of care for patients. For that reason, the topic of co-payments and fees will likely be reopened, for which the ministry has already gathered data.
Decisions on the table and a possible chance for change
In the short term, a decision is awaited on the location of the new hospital in Bratislava and on the pilot list of procedures, for which approximately 6,5 million euros has been earmarked in the budget. The transition to a standard DRG system is to continue, waiting lists and their enforcement must be addressed, and a tender is to be launched for emergency medical service providers. The discussion on co-payments and fees may significantly affect the behavior of all actors in the system.
Crises, however, also create room for necessary changes. When e-prescriptions, centralized procurement, or benchmarking were successfully launched in the past, it was thanks to decisive steps taken in hard times. The ministry now has a similar opportunity: to take less popular but useful steps that will improve efficiency and certainty for patients. If it seizes it, this year could become a turning point.
