HEALTHY SLOVAKIA

Healthcare in Slovakia has become a symbol of a failing state. Long waiting times, medical professionals leaving abroad or moldy hospitals are a visible sign of neglect.

But the biggest victim are people, their lives and the years they will live in health.Compared to other EU countries, we have too many avoidable deaths, high cancer and circulatory diseases mortality. After a lifetime of work, people enjoy the shortest pension of all the EU countries without health problems. We are lagging behind in life expectancy.

In the health service sector, we need to clean up and enforce the rules. We need a new, modern perspective. We want to start with a fundamental change: focus on people and their health. We want to subordinate hospitals organisation, state priorities and investments to a simple goal: to make people live a healthy life as long as possible. We therefore offer a programme for health, not just for health service.

The state must protect the interests and health of its citizens. It must not give way to strong financial interests in the background. In addition to the role of a thorough regulator that determines and enforces the rules, the state must fulfill the role of the owner of hospital infrastructure, which guarantees basic availability of health care in university and faculty hospitals.

To improve outcomes, we need to focus on the early diagnosis and guarantee of the quality of medical procedures. Treatment does not stop at the hospital or outpatient clinic, so it is necessary to change the settings of forms of aftercare, rehabilitation and long-term care.

The role of the state is to guarantee both quality and innovations. This requires careful measurement, control of results, and the ability to deliver innovations that improve the quality, availability, efficiency and sustainability of the system, as well as the convenience of patients and health care professionals. Finally, the state must not neglect the role of the investor who will catch up with the investment debt towards the crumbling hospitals all over Slovakia.

Health insurance companies should be responsible for the availability of health care and treatment management under close supervision of the state. For the health care to be functioning, people need to know what care and to what extent they are entitled to. Health insurance companies must be obliged to provide such care and the state needs effective tools to enforce their obligations.

On the insurance market, fairness and balanced competition must be encouraged to benefit persons insuredb. The State Health Insurance Company will play an important role in guaranteeing reforms, as it will be the bearer and instrument of change. However, we are aware of the need to exert competitive pressure on the state insurance company. If it does not produce sufficient quality, it should not be sure of its status in the future.

  1. HEALTH, NOT ONLY HEALTH SERVICE

The health system is responsible for only 20 per cent of health. Other factors are responsible for the remaining 80 per cent. The government has the opportunity to influence these other factors by taking care of the environment, the quality of food, or by supporting the development of sanitary infrastructure. That is why we focus on health, not just health care.

The priority will be to eliminate the most common causes of preventable deaths and poorer health in Slovakia: heart diseases, back pain, sudden vascular brain disease - stroke, cancer of the respiratory system, colon and rectum, liver diseases and diabetes. Prevention is the best remedy for these diseases, so we will focus on promoting a healthy lifestyle and healthy environment.

1.1. Healthy environment
  • We will more consistently protect the air, water, increase the proportion of greenery, remove environmental burdens, and develop individual health promotion plans for congested areas (for more details, see ENVIRONMENT AND ENERGETICS).

1.2. We will help and advise
  • We will build a trustworthy and comprehensive official source of health information on the Internet. We will actively combat false information and fraud.

  • We will strategically promote a healthy lifestyle and implement a comprehensive health education project for citizens. We will strengthen the capacity of health counselling.

  • We will concentrate the work of health counselling centres on group interventions, with emphasis on disadvantaged groups of the population. We will link health counselling activities with general practitioners.

1.3. Education of children towards health
  • We will promote healthy lifestyles from an early age. This includes health education and the availability of healthy diets in schools and kindergartens, support for physical activity – building public sports grounds or cycling routes, campaigns for healthy lifestyle, motivation for people and new quality contracts for doctors.

  • We will use the knowledge and experience of nurses in the area of ​​education and ensure their application in schools at the position of school nurse (for more information see the chapter EDUCATION).

1.4. Vaccination and prevention
  • We will increase vaccination with an emphasis placed on pensioners and children.

  • We will broaden preventive examinations mainly for cardiovascular diseases and cancer, which are the most common in Slovakia and we will increase the emphasis on early detection and care of diabetes patients. Early detection of civilization diseases also acts as a tool for more efficient handling of financial resources in our health care.

1.5. Mental health
  • We will present a comprehensive program to support the maintenance of mental health and to expand the capacity to treat mental illnesses. It is unacceptable that someone who has the courage to face mental problems, despite their stigma in the society, encounters inaccessibility of help or lack of interest. It means persistent suffering of people in a difficult situation or dangerous attempts of self-medication.

1.6. Fighting ailments
  • In addition to positive incentives for better health care, we will also support policies to reduce harmful behaviour. This includes campaigns against public smoking or alcohol, taxing unhealthy food, policies aimed at reducing the negative effects of gambling and addictions associated with the use of modern technologies.

  • In the area of ​​drug policy, we will promote a wide range of practices aimed at reducing harm to users, their families, the community and society at large. We will focus on the prevention, fieldwork and support of programmes that will result in the protection of the population from the negative consequences of the use of narcotic drugs and psychotropic substances. In the case of their possible medical use, any such experiment shall be subject to rigorous scientific examination. We do not consider it right when young people are persecuted for marijuana cigarettes with a criminal record or imprisonment. It is necessary to depoliticize this issue and bring solutions based on facts and discussions with experts who will determine the most appropriate solutions.

  1. PATIENTS NEED TO KNOW WHAT THEY ARE ENTITLED TO

If a person becomes ill and has to go to a doctor, it is important not to wait at 3 am in front of the outpatient clinic, not to have to travel accross the whole republic for a trivial examination, or to wait a year for examination. Patients must know what health care they are entitled to, at what time the health insurance company will provide it and where to find it.

2.1. Clear rights of patients
  • We will define the procedures to which the patient is entitled free of charge, including maximum waiting periods, geographical and material availability for specific procedures.

  • In case of non-compliance to such rights, the health insurance company will have to reimburse the examination by any provider, otherwise the state will limit its profits.

2.2. Emphasis on quality
  • Thorough implementation of clinical protocols based on the latest diagnostic and therapeutic standards and linking them to the basic entitlement of patients.

  • We will specifically focus and support the implementation, consistent application and control of internationally applicable quality standards of health care for women and children at birth and in the postpartum period.

2.3. We will take action against charges
  • By thoroughly controlling illegal and unjustified charges, we will prevent restrictions on people’s access to healthcare. We will give the authorities more powers to enforce the recovery of illegally collected charges. At the same time, we will increase sanctions and target those who circumvent the law directly or or assist with this.

  • We will determine the exact list of charges beyond the health insurance that providers will be allowed to collect. This will remove unjustified payments from patients and improve control.

  • We will introduce a ban on direct payments to health care providers. The patients will settle all liabilities with the health insurance company as part of the end-of-year annual account.

  • Začneme cez zmluvy zdravotných poisťovní s poskytovateľmi vynucovať povinnosť mať funkčný a bezplatný objednávkový systém pacientov a pacientok.

  • We will begin to enforce through the contracts of health insurance companies with health care providers their obligation to have a functional and free patient appointment system.

2.4. Better protection and control
  • We will transfer the responsibility for reviewing treatment and awarding damages to the courts. The current system with the Health Care Surveillance Authority is not functioning from the viewpoint of the protection of patient interests. In fact, it only postpones the possibility of obtaining damages by legal action.

  • We will propose to transfer financial and economic control of health insurance companies to the National Bank of Slovakia, which has expertise in the field of control of financial institutions.

2.5. Informed patients
  • We will introduce mandatory disclosure of as much information as possible on the quality and availability of health care based on quality indicators.

  • Health insurance companies will be responsible for preparing and updating the assessment and ranking of all healthcare providers.

  1.  HIGHER QUALITY, MORE INNOVATION AND COMFORT FOR PATIENTS

We will make sure that health insurance companies and doctors do not concentrate on the number of tasks performed, but on the quality of care patients receive and whether they have been cured. Health care in Slovakia urgently needs more innovations that will support system efficiency, comfort and quality of provided care. Making appointments for a specific date and time and hygiene packages should be a matter of course, not a luxury.

3.1. Quality and innovations
  • We will transform the Health Care Surveillance Authority into the Institute for Quality and Innovations. We will ensure its independence. The new competences of the Institute will include the development of standards, their implementation into practice, certification of providers, management and publication of medical data, financial support for innovation, innovative pilot projects, preparation of recommendations for the Ministry, and selection and work with leading experts.

  • Each change will have measurable criteria based on which its success and possible extension to more health insurance companies, health care professionals, and patients will be assesed.

3.2. Digital healthcare
  • We will prepare Slovak healthcare for the digital era. This means digitizing, standardizing and automating and regularly evaluating the data. This measure will also aim to reduce the administrative burden on health professionals so that they can focus more on professional, clinical activities.

  • We will introduce the principle „once and enough“ to healthcare. Neither the state nor the healthcare providers will again ask the patients for information, documents or examinations that will be recorded in eHealth. It is also inefficient for healthcare professionals to fill in the information already in the system again (more in the section DIGITAL SLOVAKIA).

3.3. Pressure on quality
  • While misconduct in the healthcare provided will punished and indemnifed by legal action, the quality of the healtcare providers performance will be enforced by the Institute for Quality and Innovations (compliance with standards, fulfilling what the patients are entitled to, security procedures).

  • We will introduce modern payment systems that motivate healthcare providers to provide successful treatment based on the quality of treatment and services, coordination between healtcare providers and patient satisfaction.

  • We will pay special attention to the reform of the purchase of healthcare in the General Health Insurance Company.

3.4. Innovations in outpatient clinics
  • We will define new performanc and introduce financial incentives (primarily through health insurance companies) to support innovations in outpatient settings. This includes, for example, telemedicine support, remote sampling, video consultation, and the like.

  • New performance and motivations will also apply to changes in work organization - for example, the employment of multiple nurses, assistants, hospital attendants, with a single physician in order to increase the capacity and efficiency of healthcare provision and comfort for healthcare professionals, and patients.

  • We will support and motivate health professionals to associate into integrated centers, which will increase their efficiency and comfort for patients.

3.5. Affordable, quality and safe medicines
  • We will combine data collection and monitoring on the availability of medicines for patients in Slovakia into one institution (currently it is divided among several authorities). The aim is to improve the ability of the state to practicably intervene in the case of unavailable medicines.

  • We will simplify the entry of generic medicines into the Slovak market – including biosimilar medicines, and we will make the generic prescription functional. We will introduce new contracts between healthcare providers and health insurance companies where the costs and risks of innovative medicines entering the treatment will be also borne by the pharmaceutical company.

  • We will continue to reduce spending on medicines, special medical supplies and medical devices by extending referencing, benchmarking and interchangeability. We will improve the selection of experts for categorization committees and at the same time make their work more professional (full-time with adequate remuneration). We will disclose information about the members of the commissions and their decisions.

  • We will eliminate duplicate examinations and prescriptions by exchanging information between healthcare professionals through eHealth system. Duplicate examinations and medicament use are not only economically disadvantageous, but also harmful to health. We will develop standards for medicament prescription and control. We will expand the central procurement of medicaments and special medical material.

  • We will allow the sale of some over-the-counter medications (for example, for colds) outside pharmacies.

3.6. Better ambulance service
  • We will improve and extend the competition in the issue of ambulance service licenses. We will digitize and connect rescue structures.

  • We will introduce policyholders’ involvement in the misuse of ambulance service, suppress the inefficient use of ambulance service for secondary transfers, and develop standard procedures for the operations center to select unjustified ambulance transports.

  1. HEALTH CARE AND HEALTHY LIFESTYLE

We will motivate people to take preventive health care and opt for a healthier lifestyle. Efforts will include education on healthy lifestyles, prevention campaigns, but also discounts, bonus benefits, health care packages, and insurance premium discounts.

 Health insurance companies will compete for insured persons with higher quality and availability of health care, but also with positive motivation. This will only be possible if each patient has a legally defined entitlement. We will allow insured persons to pay extra for extra services and materials depending on their lifestyle and needs.

4.1. Positive motivation
  • In addition to campaign motivation, we will provide bonus benefits and health care packages to those asctive insured persons who take care of their health, as well as the option to receive a premium discount. In this way, we will motivate people to better health care and reduce health care costs in the future.

  • We will introduce financial incentives gradually and assess them continuously. We will start with discounts in pilot mode, where they save the most future expenses.

  • We will ensure that there is no inadequate outage in health care resources. Therefore, we will support the possibility of getting a premium discount only where it will save future costs.

4.2. Wider choice for insured persons
  • In addition to basic standard insurance, we will introduce other options. The health insurance company will be able to provide supplementary health insurance for above-standard services and materials only if it has provided basic health care in the required quality.

  • At the same time, health insurance companies will be required to make a yearly health care account for each insured person so that they are able to better orientate themselves in the consideration provided for health insurance paid.

4.3. We will ban cross-ownership
  • By banning cross-ownership (vertical integration), we will reduce the influence of financial groups and oligarchs in the health sector and ensure fair competition. One end-owner will be able to own one type of the following: a health insurance company, a healthcare provider or a public pharmacy.

  1. PROFESSIONALISM AND PERSONAL RESPONSIBILITY IN HOSPITALS

Riadenie nemocníc je zväčša neefektívne. Štát ich necháva opakovane sa zadlžovať a postupne sa rozpadať. Sme presvedčení, že v mene základnej úlohy štátu zabezpečovať zdravotnú starostlivosť si nemôžeme dovoliť rezignovať na štátne nemocnice, ich manažment a hospodárenie.

5.1. State hospital network
  • We will create a nationwide state network that will unite all state hospitals under unified management.

  • We will not allow open or covert privatization and transformaton of state hospitals into joint stock companies.

  • We will provide professional management cut off from the politics. We will introduce truly transparent selection procedures into their management. The selection will include public hearings and the publication of CVs and other documents with which candidates apply for a position. We will support linking the widest possible component of management wages to measurable results.

5.2. Forced administration
  • The direction of more resources to hospitals will be conditioned by effective management. In addition to promoting the quality and safety of patients through stratification, we will introduce a forced administration institute. It will include harsh measures and pressure against the management of the indebted hospitals, including the revision of contractual relations, the introduction of co-decision by the Ministry and automatic exchange of management or the possibility to suspend the automatic pay growth in the debt-generating hospital.

5.3. Cost comparison
  • We will introduce a mechanism for regular comparison of costs of hospitals in Slovakia and neighboring countries. Its task will be to uncover the areas of ineffective, or, on the other hand, good management.

  • The measure will also include an in-depth audit in hospitals as a tool to prevent forced administration.

  1. INVESTMENTS WILL STOP DECLINE AND SUPPORT QUALITY

There has been no investment in health, renovation and modernization of buildings and equipment for years. Even when money came, they were often used as a marketing tool rather than a systematic development effort. We are convinced that we need to obtain far greater value for resources that go into healthcare.

6.1. Keep finances tidy
  • Fundamental equity and stability in funding will be introduced through a formula that ensures the predictable development of the overall public health package. The total package will consist of contributions from insured persons and payments by the state to fund the specified amount.

  • We will rationalize the financial resources in the health sector to redirect resources from common medical and examination components, expenditures on medicines, medical materials, aids and ambulance service into the outpatient sphere.

6.2. Public investment fund
  • We will ensure the efficiency and targeting of investments from public health insurance by creating a public health investment fund. It will combine some of the existing budgetary resources in the health sector and invest them on strictly defined criteria where they can save or improve as many lives as possible.

  • As to hospitals, we will support especially those that achieve the stated goals of the recovery plan and are not getting into further debt.

6.3. More EU funds
  • In the name of faster modernization, we will allocate more EU Structural Funds to the health sector. We will use the new operational programs for the period 2021 - 2027 with health sector as a priority area for health infrastructure, especially for new hospitals (including the University Hospital in Bratislava), modernization of medical faculties, support of science and research in health care.

  • We will use the resources of the European Social Fund and technical assistance to optimize processes and management in the health sector (defining patient entitlements, DRG, e-health and others).

  1. MORE ATTRACTIVE HEALTHCARE JOBS IN SLOVAKIA

The greatest value in health care are health professionals. If we want to provide people with high-quality health care, we have to stop the exodus of health professionals and nurses abroad and increase the attractiveness of their profession at home in Slovakia. That is why we always prepare our actions with respect to people – both patients and health care professionals.

Poor environment, politicization, corruption, poorly structured education, and poorly structured specialization structure and work organization are just some of the problems that hurt health care professionals and cause their scarcity. Therefore, we will extend the support of resident programs, introduce the rules of education and attestation, professionalize hospital management, support new models of work in outpatient and hospitals, make the work of lower health care staff more attractive and take many other measures to motivate health care professionals to work in Slovakia.

The priority will be to strengthen the role of general practitioners in health care and, overall, to strengthen the primary health care sector. In addition to addressing the acute shortage of general practitioners, we will focus on changing motivations to make treatment more result-oriented than focused on the amount of medical procedures performed.

7.1. Better education
  • We will stop increasing the number of students at medical faculties without real reform and investment in their development, which further reduces the quality of teaching and drives the best out of the country.

  • We will transform the Slovak Medical University into a standard university, or merge it with a medical faculty.

  • We will provide an annual investment in the development of hospital buildings and their equipment for the needs of students of medical faculties.

  • Medical faculties will be able to order practical instruction at any hospital so that the pressure of competition supports the quality of education. The senior consultants will be representatives of medical faculties in the hospital.

7.2. Rules for attestations
  • We will review and simplify the attestation rules for young doctors and enforce them more closely. It cannot be the case that young doctors will not be allowed to circulate in the ward for the necessary attestation or to real medical procedures, or that the attested doctors will not have time to attend to them.

  • We will improve the conditions for the education of health care professionals by, for example, writing off the cost of compulsory literature and courses from the taxable income tax base.

7.3. General practitioners as a priority
  • We will strengthen the role of general practitioners in the care of patients while supporting the possibility of transferring more competences to nurses (or other staff) in order to streamline the provision of health care.

  • General medicine will be strengthened also from the viewpoint of personnel – we will consider opening this field for other specializations, remove barriers to entry into districts, change capitation contracts to capitation -performance-quality contracts and create financial incentives in health insurance companies to increase the capacity of outpatient departments (innovations, employing more nurses etc.).

7.4. Residential program
  • We will extend the residential program to several specializations, with the cost of employing an untrained doctor borne by the Ministry of Health.

  • We will work with local governments, health insurance companies and professional companies to map and create motivational opportunities for placing doctors in those regions of Slovakia where they are most missing.

7.5. Better wages and conditions
  • We will ensure regular increases in salaries for nurses and other healthcare workers who are we are lacking most, gradually approaching the OECD average.

  • We will ensure fair remuneration in state hospitals so that the best healthcare professionals get the highest remuneration .

  • We will introduce more flexible working hours for nurses and medical staff so that, for example, one nurse can work in several outpatient departments if one doctor cannot use the full working hours of a nurse.

  • We will insist on a transparent selection of managers who will have to regularly defend their position and present their results.

  1. WE WILL PROVIDE ACCESIBLE LONG-TERM CARE

The aging of the population brings more people dependent on the help of others, whether it is to ensure a dignified old age, care for the seriously ill, or postoperative aftercare. In many cases, health care is associated with nursing care. We need a fundamental reform of long-term care that takes this into account. The new system must allow people to stay in home care as long as necessary. At the same time, it must provide a place in social facilities for those who are undoubtedly dependent on all-day assistance.

8.1. Health and social care
  • We will develop a sustainable model of combined health and social care funding that takes into account the growth in demand for aging-related services.

  • We will unify the assessment activity ragrding the reliance on long-term care under a single institution and in a single assessment, as the assessment activities are unnecessarily performed by too many institutions.

  • We will use the possibility of indicating nursing care in nursing facilities and nursing homes by experienced nurses.

  • We will ensure regular development, enforcement and control of quality standards for long-term care.

8.2. Protection of patients claims
  • We will move the provision of social contributions directly to dependant people (and not to facilities) who will be able to decide how to use them. In this way we will support the development of community care for dependant people.

  • We will introduce patients’ entitlement to after-treatment, rehabilitation services from health insurance companies and we will enforce it thoroughly.

  • We will link the after-treatment services to doctors and motivate them through new quality contracts towards faster after-treatment (for further measures see the section EMPLOYMENT).

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