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Location of the Slovak Republic (Slovakia) in Europe. Neighboring countries: Czech Republic, Poland, Austria, Hungary and Ukraine
Source publication
Healthcare system in Slovakia is neither Bismarck nor Beveridge nor National Health Insurance model, although it has certain features of all. The healthcare contributions are mandatory and are paid to the health insurance company. An insured citizen is almost unlimited as for the amount of healthcare spending but the reimbursement limits are set fo...
Context in source publication
Context 1
... Republic is located in the central Europe and neighbors with the Czech Republic, Poland, Austria, Hungary and Ukraine (Fig. 1). Slovakia is the member of the European Union and NATO since 2004. The number of inhabitants was over 5.4 million in March 2010. Basic data and description of the Slovak Republic is summarized in the Table 1. system-people who earn more pay more, those who earn less pay less, but all receive the same healthcare. Each employed citizen ...
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Citations
... In 2004, it was additionally inspired and changed according to the German healthcare system. A universal healthcare system is achieved through compulsory basic public and private insurance, which is regulated and substituted by the government through the Ministry of Health [20]. ...
Citation: Hospodková, P.; Gilíková, K.; Barták, M.; Marušáková, E.; Tichopád, A. Opportunities and Threats of the Legally Facilitated Performance-Based Managed Entry Agreements in Slovakia: The Early-Adoption Perspective. Abstract: Slovakia has adopted an amendment to Act No. 363/2011, regulating, among other things, drug reimbursement and is undergoing a significant change in the availability of innovative treatments for patients. High expectations are associated with arrangements related to performance-based managed entry agreements. Opinions and positions towards this change appear to be inconsistent, and for the further application of the law in practice and when setting up the main implementation processes, it is necessary to understand the positions and opinions of the individual actors who are involved in the PB-MEA process. The interviews were conducted in the period from 20 May to 15 August 2022 around the same time as the finalisation of the amendment to Act No. 363/2011 and its adoption. A roughly one-hour open interview was conducted on a sample of 12 stakeholders in the following groups: representatives of the Ministry of Health, health-care providers, pharmaceutical companies and others, including a health insurance company. The main objective was to qualitatively describe the perception of this topic by key stakeholders in Slovakia. The responses were analysed using MAXQDATA 2022 software to obtain codes associated with key expressions. We identified three main strong top categories of expressions that strongly dominated the pro-management interviews with stakeholders: legislation, opportunities and threats. Ambiguity and insufficient coverage of the new law, improved availability of medicinal products and threats associated with data, IT systems and potentially unfavourable new reimbursement schemes were identified as key topics of each of the said top categories, respectively. Among individual sets of respondents, there is frequent consensus on both opportunities and threats in the area of implementing process changes in PB-MEA. For the successful implementation of the law in practice, some basic threats need to be removed, among which in particular is insufficient data infrastructure.
... The Slovak Republic (SR) is a small Central European country, with a total number of inhabitants of about 5.5 million. As described by Kapalla et al., 2010, Slovakia's health insurance system is neither Bismarck nor Beveridge nor the National Health Insurance model, although it has certain features of all (Kapalla et al., 2010). Health insurance in Slovakia is based on a solidarity system that is represented by all citizens paying so-called health contributions, which are compulsory. ...
... The Slovak Republic (SR) is a small Central European country, with a total number of inhabitants of about 5.5 million. As described by Kapalla et al., 2010, Slovakia's health insurance system is neither Bismarck nor Beveridge nor the National Health Insurance model, although it has certain features of all (Kapalla et al., 2010). Health insurance in Slovakia is based on a solidarity system that is represented by all citizens paying so-called health contributions, which are compulsory. ...
Objective: Information about the access of Slovak patients to orphan medicinal products (OMPs) in the literature is rather scarce. The main aim of the study was to analyze the accessibility and availability of OMPs to Slovak patients in the years 2010–2019.
Methods: The analyzed OMPs were strictly defined according to the European definition. The date of marketing authorization together with its first appearance in the positive drug list was used to count the time to reach the national market. The data from the National Health Information Centre, the Ministry of Health, and health insurance companies were used as data sources of drug usage, expenditure, consumption, reimbursement of OMPs, as well as the total number of treated patients.
Results: Out of the 167 OMPs on the European market, we identified 52% (87) OMPs which had any kind of costs recorded in Slovakia. Out of them, 62% (54) OMPs were directly present on the positive drug list. The remaining 33 OMPs were available on exception. The trend in accessibility and availability of OMPs in Slovakia between the years 2010 and 2019 was decreasing (57% OMPs in 2010 vs. 47% OMPs in 2019). The average time for an orphan medicinal product to reach the Slovak market was almost 4 years, 43.5 months [6—202 months]. Together, 10.4% (8 815 patients) out of the theoretical patients’ estimation according to the prevalence in the orphan designation were treated with OMPs available in Slovakia.
Conclusion: Presented data clearly show insufficient accessibility and availability of OMPs in Slovakia. Importance of clearly defined criteria for OMPs supporting patients and healthcare professionals’ involvement in the final decision together with other measures such as social impact, improvement of patients’ quality of life, society wide meaning, or no alternative treatment in the final decision is crucial for transparent and sustainable access to OMPs and innovative treatments in Slovakia.
... All clients are free to switch funds. The health insurance market is dominated by the General Insurance Fund, with a share of 65 percent of the total insured (Kapalla et al. 2010). However, insurance funds' revenues are re-distributed through a risk-equalization scheme to compensate for demographic and socioeconomic differences (European Commission 2016). ...
... The National Health Promotion Program update for 2014 cites prevention-related health plans targeting, for example, circulatory diseases prevention, cancer prevention, and mental health. The most successful outcomes in individual prevention are in gynaecology, prenatal care, and childcare (Kapalla et al. 2010). Despite these preventive measures health outcomes are still unsatisfactory. ...
This chapter offers an in-depth look at health politics and the health system in Slovakia based on compulsory social health insurance. It traces the development of the Slovak healthcare system, characterized by the shift from a social health insurance model to a Semashko model of health provision under communism. Slovak post-communist health politics has been marked by strong left–right political conflict and institutional barriers to reforms. Nevertheless, health policy in Slovakia displays a dramatic shift to a market-oriented healthcare provision based on user fees and managed competition, introduced in 2003 and 2004. Attempts to reverse market-oriented reforms were partially successful and have involved supranational and international authorities of the European Commission and of the International Court of Arbitration. As outlined in the chapter, some of the main issues facing the Slovak healthcare system have been overcapacity in the hospital sector, a malfunctioning referral system, and corruption.
... 41,48,76,80,83,85,87,90,91,101,105,108,110,[113][114][115]120,123,127,128,133,136,139,142,143 Oncology budgets for outpatient care ,were available for all countries except -Estonia, Finland, Germany, and Iceland, and the prevalence rate of CRC amongst all cancers was used to calculate CRC outpatient care costs. 24,32,37 For Slovakia, the total healthcare expenditure for outpatient care was listed and we applied the percentage of outpatient care that was ascribed to CRC, using the discharge proportion of CRC from all diseases discharge total 1,71 . ...
Background
Colorectal cancer is one of the leading causes of cancer morbidity and mortality in Europe. We aimed to ascertain the economic burden of colorectal cancer across Europe using a population-based cost-of-illness approach.
Methods
In this population-based cost-of-illness study, we obtained 2015 activity and costing data for colorectal cancer in 33 European countries (EUR-33) from global and national sources. Country-specific aggregate data were acquired for health-care, mortality, morbidity, and informal care costs. We calculated primary, outpatient, emergency, and hospital care, and systemic anti-cancer therapy (SACT) costs, as well as the costs of premature death, temporary and permanent absence from work, and unpaid informal care due to colorectal cancer. Colorectal cancer health-care costs per case were compared with colorectal cancer survival and colorectal cancer personnel, equipment, and resources across EUR-33 using univariable and multivariable regression. We also compared hospital care and SACT costs against 2009 data for the 27 EU countries.
Findings
The economic burden of colorectal cancer across Europe in 2015 was €19·1 billion. The total non-health-care cost of €11·6 billion (60·6% of total economic burden) consisted of loss of productivity due to disability (€6·3 billion [33·0%]), premature death (€3·0 billion [15·9%]), and opportunity costs for informal carers (€2·2 billion [11·6%]). The €7·5 billion (39·4% of total economic burden) of direct health-care costs consisted of hospital care (€3·3 billion [43·4%] of health-care costs), SACT (€1·9 billion [25·6%]), and outpatient care (€1·3 billion [17·7%]), primary care (€0·7 billion [9·3%]), and emergency care (€0·3 billion [3·9%]). The mean cost for managing a patient with colorectal cancer varied widely between countries (€259–36 295). Hospital-care costs as a proportion of health-care costs varied considerably (24·1–84·8%), with a decrease of 21·2% from 2009 to 2015 in the EU. Overall, hospital care was the largest proportion (43·4%) of health-care expenditure, but pharmaceutical expenditure was far higher than hospital-care expenditure in some countries. Countries with similar gross domestic product per capita had widely varying health-care costs. In the EU, overall expenditure on pharmaceuticals increased by 213·7% from 2009 to 2015.
Interpretation
Although the data analysed include non-homogenous sources from some countries and should be interpreted with caution, this study is the most comprehensive analysis to date of the economic burden of colorectal cancer in Europe. Overall spend on health care in some countries did not seem to correspond with patient outcomes. Spending on improving outcomes must be appropriately matched to the challenges in each country, to ensure tangible benefits. Our results have major implications for guiding policy and improving outcomes for this common malignancy.
Funding
Department for Employment and Learning of Northern Ireland, Medical Research Council, Cancer Research UK, Health Data Research UK, and DATA-CAN.
... Since 1990, the former centrally planned economy has been transformed into a market economy. Slovak Republic is located in the central Europe and neighbors with the Czech Republic, Poland, Austria, Hungary and Ukraine (Kapalla -Kapallová -Turecký, 2010). ...
... 1 The national health care system The health care system in Slovakia can neither be described as Bismarckian nor Beveridgean nor follows a National Health Insurance model, although it has certain features of all three. There is virtually 100 % solidarity implemented within the system -people who earn more pay more, those who earn less pay less, but all receive the same health care (Kapalla -Kapallová -Turecký, 2010). The health care system in Slovakia is based on universal coverage, compulsory health insurance, a basic benefit package and a competitive insurance model with selective contracting and flexible pricing. ...
The chapter provides a deeper insight into health care within the Slovak Republic, a state located in central Europe. It introduces the national health care institutions and their mutual relations, as well as the fundamental legislation. Then the contribution presents the financing of the health care and a system of health insurance. It mainly focuses on the right to health in Slovakia and on its justiciability. It uses three concrete examples (Simon Buch, Sebastian and compulsory vaccination) in order to illustrate how the justiciability of the right to health works in the country.
Keywords: Health Care, Health Insurance, Justiciability, Slovakia.
Introduction:
This overview paper aims at summarizing and analyzing the available literature on healthcare system organization and pricing policies of 11 European countries, comparing them to the Bulgarian pharmaceutical system. The countries were selected based on the reference basket for the pricing of pharmaceuticals in Bulgaria - Belgium, Greece, Spain, Italy, Latvia, Lithuania, Romania, Slovakia, Slovenia, and France.
Areas covered:
In the first part, we explore the health system models in the above-mentioned countries. In the second part we explore the pricing and reimbursement policies, and in the third part we analyze healthcare and pharmaceutical economic indicators, as well as life expectancy. The major focus of the review is the outpatient care.
Expert opinion:
In this work, we attempted to outline differences and similarities between the countries of interest. Despite the differences in their healthcare system organization, health and pharmaceutical expenditures constantly increased during the observed 2 decades. This increase in expenditures, however, has not had a significant impact on life-expectancy. Minor increases were observed - from 2 to 4 years total. No country had an expectancy above 85 years of age. It might be said that other factors are influencing the life expectancy to a greater extent.
Advance Directives have been legally binding in Spain since the publication of Act 41/2002, of 14th November, which regulates patients’ rights to autonomy and obligations concerning clinical information and recording clinical information. However, the situation in each country of the European Union remains heterogeneous and unknown to most health care professionals.
By collecting and studying the legislation on patients' rights in European Union countries we have made an updated comparison of the different features of Advance Directives in each country.
Only 15 of the 28 European Union Countries have developed specific rules on advance directives which makes them legally binding in 86% of cases if they are written. A formal Advance Directive signed before a notary, a civil officer or a witness, is required in only 7 countries. The designation of a patient’s attorney for health matters is regulated in 11 of the countries. There is an Advance Directives Register in 3 countries, whereas in the other countries it is only included in the medical record. Regular revision of an advance directive document, to maintain its validity, is required in five countries. All legislations provide for amendments and the revocation of advance directives, as they forbid unlawful actions. Rejection of routine supportive measures and treatment limitation are the main content of advance directives, although specific treatment applications are viewed as guidance.
There seem to be many differences between laws concerning advance directives among the European Union Countries. A more homogeneous legislation, publicized and applied within the wider social consensus, would be desirable.
Resumen
La Ley 41/2002, de 14 de noviembre, básica reguladora de la autonomía del paciente da valor legal vinculante a las voluntades anticipadas (VA) en España. Sin embargo, la situación en cada país de la Unión Europea es distinta y desconocida para la mayoría del personal sanitario.
Para conocer esas diferencias, se realizó una recogida y estudio de las distintas legislaciones en materia de derechos del paciente, y se estableció una comparativa actualizada de las características que cada país otorga a las VA.
De los 28 países de la Unión Europea, 15 han desarrollado legislación específica en materia de VA, y le otorgan carácter vinculante el 86% si se utiliza la formulación escrita. Siete países exigen formalización del documento de voluntades anticipadas (DVA) ante notario, testigos o ante representantes de la Administración. La figura del representante se contempla en 11 países. En 3 países existe un registro de VA, mientras que en el resto el DVA solo se incluye en la historia clínica. En 5 países se exige la revisión periódica del documento, que pierde validez pasado este periodo de vigencia. Todas las legislaciones prevén modificaciones y la revocación de las VA. El contenido de las VA suele referirse al rechazo de medidas de soporte y limitación de tratamiento, aunque las solicitudes de tratamiento específico se contemplan como orientativas.
La legislación sobre VA en la Unión Europea es muy diversa, con múltiples connotaciones específicas en cada país. Sería deseable una legislación más homogénea, divulgada y aplicada, de acuerdo con la sociedad actual.
A growing body of evidence over the past twenty years suggests that electronic prescribing (ePrescribing) can bring a host of benefits to the health sector, and some policy makers now view ePrescribing as a desirable national service that can improve the safety, quality and efficiency of healthcare. Consequently, national ePrescribing and electronic health record (EHR) projects have been launched in many countries in recent years, but success is elusive as ePrescribing in primary care is still unavailable in over 90% of countries worldwide. Progress has been limited to a small number of countries, with a significant cluster in Europe.
Why is the adoption of ePrescribing and EHRs slow and uneven? What are the factors that influence the development and adoption of ePrescribing? What are the building blocks for a national ePrescribing service? What are the lessons from the leading countries? What are the policy lessons for countries where national ePrescribing services are not yet developed?
This research addresses these questions. Qualitative methods were used, including a
comparative analysis of case studies in thirty one European countries and interviews with
national ePrescribing experts in the leading countries. A cross-domain comparison was
undertaken with a leading eGovernment service in Ireland - the Revenue On-Line Service
(ROS) – and interviews were held with national Revenue experts. The context, content and process framework from Pettigrew and Whipp’s model of strategic change and Roger’s diffusion of innovations model provide the conceptual frameworks for analysis and comparison.
The research found that ePrescribing services in primary care are now available on a national basis in eleven countries in different regions of Europe. A model for national ePrescribing is emerging over time, which includes local EHR integration, interoperability between prescribers and pharmacists through a national ePrescription database, and a trend towards on-line patient access to medication data using the Internet.
In many other European countries ePrescribing and in particular the electronic transmission of prescriptions (ETP) is underdeveloped due to a range of organisational, legal, technical or other barriers. In these countries, the absence of a developed national ETP service is the greatest barrier to adoption. The adoption patterns of recent years suggest that a technical-legal ePrescribing divide exists in Europe between the leading and the following countries.
The comparative analysis discovered that a strong inner context is the cornerstone of success in the leading countries and ROS. A strong inner context can shape the outer context, develop quality content and create a supportive process for adoption and diffusion. The findings suggest that this can be achieved through a complex process of continuous stakeholder management. Building blocks were also identified in the outer context in the legal and technological areas, where the national health model in operation emerged as the key contextual factor. The quality of the content was found to be a key adoption factor, including the interoperability, security and usability of ePrescribing systems and ETP services. The key critical success factor for the adoption of ePrescribing and ROS was found to be stakeholder management in the adoption process over a long period. Supporting factors included social marketing strategies, incremental implementation methods, quality user support and the judicious management of consent, incentives and mandates. The overall approach used by the leading countries emerges as a balance of central control and direction from the inner context, coupled with widespread permanent stakeholder management across the domain including the outer context and the private sector, leading to a complex process of development and adoption over a long period. This equates to a combination of the traditional top-down and bottom-up approaches, which Coiera has described as middle-out.
The findings in this research may contribute to policy in this area, Irish policy in particular.
