The Slovak Way on how to Improve the Healthcare System Efficiency

Adriana Liptakova, MD, PhDMinistry of HealthSlovakia

Country facts Capital Bratislava Total Area 49,035 km2 Population 5,429,763 (2010 est.) Official Language Slovak Life Expectancy 70,85 (male) 78,73 (female)

(2008) National Day 1 September Day of the

Constitution of the Slovak Republic Ethnic Group Slovak, Hungarian, Roma,

Czech Religion Roman Catholics, Protestants,

Eastern Orthodox 

Government Type Multiparty democracy

President President Ivan Gašparovič Economy GDP $88.208 billion (2009 est)

GDP-per capita $16,281(2009 est) Unemployment rate 12,1% (2010) Imports 3 851,1 mil. € (July 2010) Principally fom Russia

and Asia: China, Corea, Taiwan and Japan. Mainly components for radio, TV, cars and oil products.

Exports 3 757,3 mil. € (July 2010) The main industry sectors are car manufacturing and electrical engineering. Since 2007, Slovakia has been the world's largest producer of cars per capita,[63] with a total of 571,071 cars manufactured in the country in 2007 alone.[63] There are currently three automobile assembly plants: Volkswagen's in Bratislava, PSA Peugeot Citroen's in Trnava and Kia Motors' Žilina Plant.From electrical engineering companies, Sony has a factory at Nitra for LCD TV manufacturing, Samsung at Galanta for computer monitors and television sets manufacturing.

The Slovak health system is a system in progress

Major health reform in the period 2002-2006 introduced a new approach based on managed competition.

Although large improvements since the 1990s were made (e.g. in life expectancy and infant mortality), health outcomes are generally still substantially worse than the averages for the EU-15 but close to the other Visegrad 4 countries.

Per capita health spending (in PPP) was around half the EU15 average. A large share of these resources were absorbed by pharmaceutical spending (28% in 2008, compared to 16% in OECD countries).

Healthcare Surveillance Authority

HealthcareInsurance company Healthcare providers

Ministry of Health

Municipalities

Government

Professional Associations

admission

licence

admission

Insured person

payer

Healthcare providedPayment of insurance

application

inspe

ction

inspe

ction

contract

www.hpi.sk

Healthcare insurance companiesHealthcare providers

Ministry of Health

Gov.

Municipalities

Ministry of Transportation, Post and Telecommunication

Private owners

Common HIC

Healthcare Surveillance Authority

Departmental healthcare facilities

Pharmacies

Outpatient rooms

Hospitals

Emergency services

Specialized hospitals

University and faculty hospitals

Ministry of Defense

Ministry of Interior Affairs

General HIC

hospitals

Outpatient clinics

Emergency services

Outpatient clinics

Private HIC

inspection inspection1 HIC

2 HIC

www.hpi.sk

67%

33%

The Ministry of Health The Public Health Authority The National Institute for Drug Control The National Emergency Centre The National Centre for Health

Information The National Institution for

Transfusion and Blood suplies The Slovak Medical University

Health Indicators in Slovakia Average life expectancy grows (2001-20101,35year) Still high infant mortality rate: 5,86 per 1000 live births Increase of Diabetes mellitus Main causes of death (2008):1. Cardiovascular diseases (52,9%)2. Cancer (22,1%)3. External causes (5,9%) Therefore aims of National Health Policy are focused on 4 priorities:1. Cardiovascular diseases, oncological diseases, obesity and overweight,2. Tobacco and Alcohol,3. Enviroment and Health,4. Children

The Public Health Authority is responsible for state administration and coordination of Public Health in Slovakia.

Self-Governing Regions

Issue permits for healthcare facilities Managment of local network Take over responsibilities of

healthcare providers Sanctions: finance penalties or

revocation of license

Area2009

In-patient Hospitals

Slovakia 147

Bratislava 24

Trnava 9

Trenčín 12

Nitra 16

Žilina 13

Banská Bystrica 25

Prešov 25

Košice 23

NCHI, 2010

Physicians and nurses

2000-2009 Physicians(per 10 000 population)

Nurses and midwifes(per 10 000 population)

Slovakia 16868(31)

35757(66)

Ireland 13141(31)

67245(158)

World Health Statistics WHO,2010)

Health Economics

Health expenditure as a share (%) of GDP in the WHO European Region, 2008, WHO estimates

Slovakia 7,8%Slovakia 7,8%

Ireland 8,7%Ireland 8,7%

Health expenditure in US$PPP per capita in the WHO European Region, 2008, WHO estimates Source: WHO, Health for All Database, updated July 2010

SlovakiaSlovakia 1717 USD1717 USD

IrelandIreland3676 USD3676 USD

Total Expenditure on Health (% of GDP) in 2007(2009)

Public sources 4,9%(5,8%)1. Public health insurance 4,7%(5,2%)

2. Debt Settlement 0,0%(0,3%)

3. MoH (eurofunds incl) 0,2%(0,3%)

Private sources 1,5%(1,8%) Total sources 6,4%(7,6%) Expenditure 7,7%(7,3%)

portal.statistics.sk

Healthcare expenditure (2009)

Drugs and medical aids 32%1. Drugs 29%

Ambulatory care 35%1. Primary care 8%2. Specialists 12%3. Dentists 3%4. Diagnostics and labs 12%

Hospitals 24%

How to be more effective?

Elections in June 2010

Change from left of centre parties government to right of centre parties government (SDKÚ, KDH, SaS and Most-Híd)

Ministry of Health under Christian Democratic Movement liability

Minister of Health: Ivan Uhliarik, MD

Main challenges E-health Expert forum „Health 2020“ Standardisation of therapeutic and

diagnostic methods Human resources (2800 physicians in EU) Support of research and development Well-Informed patient National Programmes focused on

Prevention

Government Manifesto

Main challenges for providers Transformation of contributory hospitals to joint-stock

companies Accreditation of health-care facilities E-health Strengthening of urgent healthcare chain Ethics and transparency between HIC and providers Human resources Support of: nursing provided at home, one-day surgery,

outpatient services Prescription based on active substance Implementation of Diagnosis-related group-system Minimal network: based on number of beds – 10-15%

reduction, urgent hospital network, terminal hospital network - cancellation

Government Manifesto

Main challenges for HIC

Reduction of broad basic benefit package E-health Ethics and transparency between HIC and providers Standardisation of therapeutic and diagnostic

methods Degressive margin for drugs Support of nursing provided at home Implementation of Diagnosis-related group-system Additional insurance

Government Manifesto

What we have done? First hospitals were selected for

transformation Conceptual framework for urgent

healthcare chain is prepared for Government´s approval

Price referencing - 2nd lowest price in EUReimbursment decision is the competence of MoH and its reimbursment committees based on drug effectiveness, safety data and pharmacoeconomic analysis

Catalogue of healthcare performances

Next steps for further improvements

Area Future options

Financing Reform of FundsBasic benefit package

Hospitals University hospital in Bratislava

Payment mechanisms

GP - Payments per capitaOutpatient specialists – DRGInpatient healthcare - DRG

Report on Current Healthcare in Slovakia, in process

Our strategy is well known but...

Healthy population=

Good economics =

Worthwile target for all(government, citizens, employers)

Thank you for your attention!

Adriana.liptakova@health.gov.skwww.health.gov.sk