Palliative care in Slovakia is growing rapidly, but it lacks systematic quality measurement and coordinated data collection. Experts and insurers agreed that without clear indicators, the question of effectiveness remains unanswered. Experience from the Czech Republic shows that pilot projects and a shared data platform can shift the debate from fears of oversight to tracking real impacts on the patient and the system.
Without data, quality is just a guess
In recent years, Slovakia has invested in building palliative care providers, but quality oversight is lagging. Insurers point out that with lump-sum payments they only see that a visit took place, which team was involved, the diagnosis, and how many kilometers were driven. What is missing is a picture of what actually happened with the patient and what the outcome of the care was. That is why they are calling for adjustments to reimbursement mechanisms at the next revision of the fee schedule.
The panel agreed that indicators need to be clearly defined and collected: emergency service calls, use of acute care, administration of opioids, as well as patient and family comfort. The Czech experience advises not to start with "control" but with observing impacts in pilots with precisely defined teams and mentoring. There, the impact of specialized palliative teams on place of death, use of intensive care, and the number of ambulance dispatches was demonstrated. It is crucial to distinguish quality indicators for the patient and for the system – not mixing "apples and oranges".
What the available numbers say – and what we still don't know
According to insurers' administrative data, roughly 17 million euros were paid for palliative care last year for more than 3 000 patients. Of that, 70% went to brick-and-mortar hospices, 26% to palliative wards and outpatient palliative care, and 4% to mobile hospices. Brick-and-mortar hospices doubled their revenues, admitted approximately 150 more patients, and shortened the average length of stay from 37 to 32 days. But the volumes alone do not say whether quality or efficiency improved.
The average cost per case was around 6 700 euros in a hospice and approximately 6 500 euros on a palliative ward. Mobile hospices cared for about 1 900 patients, the average reimbursement per visit was 41 euros, and this year it is set to rise significantly. Experts, however, emphasize that without a "control group" and linkage to clinical and soft data, neither the benefits nor potential savings can be evaluated. They are therefore calling for analysis of administrative data from insurers and state institutions, making them available to the professional community, and specifying who will coordinate the analyses and on what timeline.
Where to start: network, reimbursement, competencies
Slovakia has a minimal network defined according to the recommendations of the European Association for Palliative Care, but in practice it runs into nonfunctional facilities in the registry and uneven availability. The network should be assessed by actual contracting, staffing and material resourcing, and availability expressed in minutes. In parallel, it is necessary to purposefully build professional capacity – from guarantors and teams to the inclusion of palliative medicine in undergraduate education. Only then will "cherry-picking" of simpler cases be prevented and fair access ensured for more complex patients as well.
The reimbursement model should have a transitional period with trust and a clear review date (e.g., in 2–3 years), during which team performance and patient trajectories will be monitored. Alongside hard data, it is necessary to collect standardized questionnaires on quality of life and family satisfaction. Since palliative care also covers social and spiritual needs, the debate should account for multi-source financing. The key is a joint platform of providers, professional societies, insurers, and state institutions that first asks the right questions and then sets measurable answers – and, based on them, the network and reimbursement.
