Slovakia: #28 in the 2024 World Index of Healthcare Innovation

Introduction

Slovakia holds the 28th position in the 2024 World Index of Healthcare Innovation, achieving an overall score of 38.99. The country’s strongest performance is in Fiscal Sustainability, in which it ranks 11th, attributed to its relatively low healthcare costs.

Conversely, Slovakia’s rankings are less favorable in Science & Technology and Quality, both at 29th. These lower rankings stem from deficiencies in medical infrastructure, a lack of patient-centered care, and lack of investment in medical and scientific research.

Background

Before World War I, Slovakia was part of the Austro-Hungarian Empire, which established a healthcare system in 1887 that was inspired by the Bismarck model in Germany. This system persisted through Slovakia’s history in various forms, adapting to the political and social transformations of the region.

Upon gaining independence in 1918, Czechoslovakia expanded health insurance coverage to include all wage earners, their families, and agricultural workers. In 1924, the private health funds were unified under the Central Social Insurance Fund (Ústřední sociální pojišt’ovna, ÚSP). This system underwent a significant transformation in 1948 under communist rule when the ÚSP was replaced by the Central National Insurance Fund (Ústřední národní pojišt’ovna, ÚNP), and again in 1952 when it transitioned to a Soviet-style socialist healthcare system.

Following the split from Czechoslovakia in 1993, Slovakia reinstated a Bismarck-style health insurance system. Initially, 13 private insurers operated in the market, but through mergers and consolidations, only four remain today. This system has evolved to resemble Switzerland’s health insurance framework, in which all citizens are mandated to enroll in private health insurance, predominantly funded through payroll taxes. Slovakians enjoy the freedom to choose their insurance provider. Currently, the major players in the insurance market are General HIC, Dôvera, and Union, with General HIC holding approximately two-thirds of the market share and remaining state-owned.

The Slovak government plays a crucial role in healthcare by determining the list of drugs covered by insurance and setting reimbursement rates through an external reference pricing system. It has the authority to exclude certain medications from coverage. Prices for over-the-counter and non-insurance-covered prescription drugs remain unregulated. In 2022, healthcare spending accounted for about 7.8 percent of Slovakia’s GDP, with public expenditures representing 75 percent of total healthcare spending.

Slovakia employs a hybrid health insurance system that integrates elements of Bismarck’s model with regulated competition among private insurers. The system ensures universal coverage while promoting consumer choice, underpinned by strong government oversight to maintain affordability and access. The government’s involvement in drug pricing and reimbursement policies helps to control costs while ensuring that essential medications are accessible to the population. This system, coupled with the consolidation of insurers, has led to a competitive yet stable insurance market focused on efficiency and patient care.

With a population coverage rate nearing 99 percent, Slovakia’s healthcare system effectively provides universal access. The system’s responsiveness is highlighted by its ability to manage an average of 2.3 hospital beds per 1,000 inhabitants and a physician density of 3.4 per 1,000, which aligns with European standards. This comprehensive approach enables Slovakia to adapt to both contemporary challenges and the evolving needs of its population, ensuring that its healthcare system remains robust and responsive.

Dimension Performance

Quality 

Slovakia faces challenges in delivering high-value healthcare, consistently ranking low in several key metrics. The country is positioned 29th overall in healthcare quality. Similarly, it ranks 30th in preventing diseases, indicating a significant area for improvement in addressing conditions that are considered avoidable with effective healthcare intervention.

In terms of patient-centered care, Slovakia is placed in the lower quartile, ranking 22nd. This reflects a need to enhance patient satisfaction and the customization of care to meet patient needs more effectively. Furthermore, Slovakia’s healthcare infrastructure is near the bottom of the Index, ranking 28th. This suggests that improvements in healthcare facilities, technology, and staffing are necessary to elevate the standard of care provided.

Slovakia’s pandemic preparedness also highlights areas of concern. Initially, the country managed to avoid high numbers of COVID-19 fatalities during the first wave in the spring of 2020. However, it faced severe challenges during the winter of 2020-21, with one of the highest rates of COVID-19 fatalities during this period, leading to a ranking of 27th in pandemic preparedness. This fluctuation underscores the need for a more robust healthcare system capable of managing public health crises effectively.

Choice

Slovakia faces challenges in delivering optimal healthcare services to its citizens, evidenced by its 15th ranking in Choice. However, the country ranks favorably in terms of the affordability of health coverage, securing the 9th position. Nonetheless, the limited freedom to choose healthcare providers and access to new treatments are significant concerns, as Slovakia ranks 17th and 19th in these categories, respectively.

Science & Technology 

Overall, Slovakia is ranked 29th in Science and Technology. The country is positioned 30th for its contributions to scientific discoveries and 24th in medical advances. Slovakia also faces challenges in deploying and fully benefitting from health digitization, where it ranks 25th. This marks a significant shift from the previous year when Slovakia was 12th in health information technology adoption. 

Fiscal Sustainability 

Slovakia achieved an above-average ranking in Fiscal Sustainability, placing 11th overall. This strong performance is attributed primarily to the low cost of care. The country has seen improvements in several key areas: it ranked 17th in national solvency, 15th in public healthcare spending, and an impressive 6th in the growth of public health spending.