Bratislava, Slovakia – Slovakia’s healthcare sector is in a notoriously bad shape: underfunded, underperforming, lacking supplies and, more importantly, doctors and qualified personnel. As Slovakia continues to fight the spread of the novel coronavirus, now seems as good a time as any to take a look at what’s wrong with its healthcare.
The state of Slovakia’s healthcare sector has rightfully taken centre stage and ranks among the biggest concerns of the population. Calls for badly needed and long overdue structural reforms has always been part of the political discourse from officials across the political spectrum for the last 30 years. But years go by and nothing really changes – at least not for the best. Why is Slovakia’s healthcare sector failing so horribly? And what could be done to address its shortcomings?
Where’s the money for healthcare in Slovakia?
As is the case in many other European countries, Slovakia’s most critical sectors are often critically underfunded (education, transport infrastructure, healthcare…). Due to insufficient funding, many state-run institutions and facilities are unable to run and perform properly and in par with European standards. Calls for reform and more funding often reach their peak during election time, with all parties more or less agreeing that the sector is in shambles, but often go unheeded and fail to have any consequence in the long-term.
Nevertheless, the healthcare budget reached a historic high of €5,2 billion in 2019, an increase of slightly more than €300 million compared to the previous year. According to the Slovak Health Ministry, this budgetary increase is due to higher spending, increased revenues and a boost of healthcare workers’ wages, which should continue to increase this year, according to statements made by government officials before the crisis.
But Slovakia still lags behind other neighbouring countries. According to a study by the European Commission, Slovakia spent just 7.1% relative to GDP, while Austria, for instance, spent 10.4%. Most of its neighbours, except Poland and Ukraine, allocated more funds to their respective healthcare sectors than Slovakia. These shortcomings have a direct impact, not only on the notoriously poor state of the health facilities and technologies used, lagging far behind other European countries’ standards, but also on healthcare workers’ unattractive salaries and benefits, one of the main causes of doctors and nurses’ mass exodus to other countries.
The ongoing brain-drain of doctors and nurses
Ever since Slovakia joined the EU in 2004, large parts of the population emigrated – either permanently or on a temporary, part-time basis – to find better work opportunities abroad and earn higher salaries. Slovaks moved en masse to countries like Austria, Czech Republic or Germany, with estimates considering that 300,000 of them left to work abroad in the last 15 years.
The country’s healthcare sector is arguably one of the most impacted by this emigration drive, with doctors, nurses and other healthcare workers leaving the country, its hospitals and institutions with a dramatic shortage of qualified personnel. One of the main reasons for this brain-drain is of course the more attractive salaries and job opportunities Slovak workers can find in neighbouring countries, including by simply crossing the border to Austria, to earn double or triple the salary they would receive back home.
Promises, hollow promises
Throughout the years, various governments and political parties promised to reinvigorate the health sector, but these promises resulted in mostly small changes and failed to address structural shortcomings at the core of Slovakia’s healthcare sector.
One of the current government’s most controversial response and solution to modernize hospitals and health technologies was to quietly privatise and sell several hospitals to the Penta financial group, one of the most powerful conglomerates in Slovakia with a well-known feisty relationship with the government and its former head, Smer leader Robert Fico. The idea was to boost revenues in order, at least partially, to alleviate the already strained budget.
Although analysts argue that some of these hospitals were indeed modernized in a much-needed way, this practice also gave way to a number of unsavoury consequences, including the increase of hospital renting spaces and facilities, pushing away private doctors unable to pay the fees and forced to set up their practices in other clinics or buildings.
Some personal experiences
To get a more comprehensive picture, I’ve talked to several doctors and health workers (who wished to remain anonymous) in Dunajska Streda, my hometown, where the main hospital was sold to Svet Zdravia, part of the Penta financial group. One of their main concerns was that the rooms in hospitals skyrocketed following its privatization, forcing them to leave to other clinics that were soon built in and around the town, like the Sagax Clinic (with operations in plastic surgery, angiology, orthopedy, gynaecology, among others), Free Clinic (general practitioners, diabetology, cardiology) and other establishments.
Although they tried as much as possible to continue working as they had always done, they were still forced to send patients to hospitals in some cases for lack of appropriate equipment and technologies. Similar situations across the country only add to the chaos of Slovakia’s healthcare sector.
Many nurses admitted that they would rather work abroad than endure life as a nurse in Slovakia due to the low pay, but not everyone has the means to move to a foreign country. To address these labour shortages in the healthcare sector, Slovakia has also seen an influx of Ukrainian nurses, for whom the Slovak wages remain much more attractive than the ones back home.
Healthcare in Slovakia: a broader problem at hand
The best probable solution is obvious: higher salaries for hospital workers and more public funding for the healthcare sector. But the government and public authorities remain reluctant to take the appropriate steps in that direction. One way would be to create a more unified approach through to identify the most urgent needs of hospitals, healthcare workers and other healthcare-related issues, and thus increase the efficiency of public expenditure.
But there’s more at stake than meets the eye. As other areas of public policy, deeply-entrenched corruption keeps Slovakia’s healthcare in a backwards state, obstructing attempts at modernization and keeping large bulks of funding from reaching their due destination. Hopes are high following the election win of anti-graft parties earlier this year, as is the pressure on the new government, which has made fighting corruption one of the pillars of its manifesto, to deliver on its promises.