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According to OECD data, in 2007 Slovakia spent 7.7% of GDP on healthcare, ahead of the Czech Republic and Poland, but below the OECD average. Private expenditure on health accounted for 33% of all health spending in 2007. Slovakia has an insurance-based system of healthcare financing, involving mandatory employer and employee contributions. The state pays for those not in employment, such as children and pensioners. Legislation in 1995 paved the way for multiple, non-profitmaking insurance funds. Citizens have a free choice of insurer. All health insurers offer the same package of benefits, and coverage is comprehensive, although modest user fees have been introduced for certain services. There are currently five health insurers in operation, although ongoing consolidation is expected to bring this number down as smaller insurers will be squeezed financially.
In 2007 the IMF suggested that reforms to introduce a greater role for market mechanisms will be needed. The Health Policy Institute (HPI), an influential think-tank, warned in April 2008 that unless the share of private participation in the healthcare sector is increased, deteriorating demographics could cause the sector's financial deficit to expand markedly. This government, and any centred on Smer-SD—the party of the prime minister, Robert Fico—is unlikely to heed this advice, seeking instead more statist solutions. The government, which has been riding a wave of popular discontent concerning the previous government's reforms, has already dramatically reduced the incentives for attracting private capital into the healthcare system, and will continue to increase the state's role both in funding and in providing healthcare.
The Slovak healthcare sector underwent thoroughgoing reform under the previous government. Before 2003 the sector had been creating debt worth around US$400m annually, lacked any stimuli for efficient use of money and suffered from widespread corruption. The healthcare policy of the current, predominantly centre-left government will continue to focus on halting, and to a great extent reversing, the previous government's free-market reforms. To this end, the transformation of hospitals into joint-stock companies has been halted, and legislation has been adopted that forces health insurers to reinvest profits into healthcare services—with a view to eventually returning to a single, state-run health insurer. However, government health policy has largely lacked direction and momentum, and this is unlikely to change under the government in place after the election due in mid-2010.
General practitioners (GPs) are mostly independent, but have contracts with the health insurance funds. An increasing share of specialists are in private practice, working under contract for insurance funds; the remainder are state employees. Healthcare professionals are expected to continue to agitate for higher wages, entailing the risk of labour unrest in coming years. The government is trying to make progress in the field of e-health. With this in mind, in May 2009 the finance ministry launched a call relating to a project that aims to ensure central provision of public information related to the health sector and the provision of other medical services via electronic means.
The convergence of demographic trends with those typical for western Europe has accelerated since 1989 as both the average age of first marriage and the incidence of divorce have increased. In 2009 average life expectancy at birth is an estimated 75 years—up from 70 years in 1990, but still slightly lower than in the Czech Republic and Austria. However, life expectancy remains below Western levels and is also slightly lower than in the Czech Republic. The main causes of lower life expectancy are poor diet, little emphasis on preventive healthcare, high levels of airborne and water pollutants, and high rates of alcohol and tobacco use. The slow increase in life expectancy comes despite more rapid improvement in reducing the infant mortality rate, which has fallen from 12 per 1,000 live births in 1990 to an estimated 6.8 per 1,000 live births in 2009—similar to that in Hungary, but behind Poland and the Czech Republic.
Mortality indicators are negatively influenced by the Roma minority in Slovakia, which has a lower standard of living than the rest of the population. Health indicators in Slovakia are forecast to remain on a positive trend over the next five years: average life expectancy is expected to rise slightly over the forecast period, and the infant mortality rate is forecast to fall. However, Slovakia will still lag behind most of its regional peers and western Europe on both counts.
The findings of the Health of Nations Index are presented here, along with accompanying information and data on over 50 countries.
Start by scrolling around the map. Hovering over a country will reveal its index results. Click through to find the underlying data and other profile information. Use the tabbed filters above the map to browse by category filter.
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