WIHI

Slovakia: #29 in the 2021 World Index of Healthcare Innovation

Slovakia suffers from limited health insurance choices and poor health outcomes.
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Introduction

Slovakia ranks 29th in the World Index of Healthcare Innovation, with an overall score of 37.70. Slovakia performed strongest in Fiscal Sustainability (#14, 59.06), owing to its relatively low cost of care.

On the other hand, Slovakia performed poorly in Science & Technology (#30, 14.32) and Quality (#30, 28.75) due to its poor standing in medical infrastructure, lack of patient-centered care, and poor health outcomes.

Background

Prior to World War I, Slovakia was part of the AustroHungarian Empire, which in 1887 instituted a health care system similar to the one installed by Otto von Bismarck in Germany.

When Czechoslovakia gained its independence in 1918, following the dissolution of the Austro-Hungarian empire, the new country expanded its health insurance system to all wage earners, including agricultural workers, and familial relatives of blue-collar workers. In 1924, these private funds were consolidated into a single regulator, the Central Social Insurance Fund (Ústřední sociální pojišt’ovna, or ÚSP). In 1948, under communist rule, the ÚSP was replaced by the Central National Insurance Fund (Ústřední národní pojišt’ovna, or ÚNP), and ultimately in 1952 with a Soviet-style socialist system, which in today’s terms is similar to that of the British National Health Service.

After the fall of the Berlin Wall and the dissolution of Czechoslovakia in 1993, the Slovakian government reinstated the Bismarck-style system. By 1997, there were 13 private insurers, though today mergers have left only 4 still standing.

Today, Slovakia’s health insurance system is similar to that of Switzerland’s. Every Slovakian is enrolled in private health insurance, the costs of which are largely funded through payroll taxes. Slovakians have freedom to choose their insurance plan; however, as a result of the aforementioned consolidation, there are three main health insurers in Slovakia: General HIC, Dôvera, and Union. General HIC, which has roughly two-thirds market share, is state-owned.

The government defines which drugs are covered (and is free to exclude drugs from coverage), and also sets the reimbursement rates through an external reference pricing system. Prices for over-the-counter drugs and prescription drugs not covered by insurance are unregulated.

Quality

Slovakia struggles in its delivery of quality health care, ranking second-to-last (30th) overall. Matching that overall ranking, Slovakia ranked last on measures of detecting and addressing preventable disease. Likewise, Slovakia’s patient-centered care ranks in the lower quartile (26th), and its health system infrastructure ranks in the bottom third (22 of 31). Like many eastern European countries, Slovakia largely avoided the first wave of COVID-19 fatalities in the spring of 2020, but was among the worst hit over the winter of 2020–21. Accordingly, its ranking on pandemic preparedness and response ended up 29th.

Choice

Slovakia struggles to provide quality choice options for its citizens, ranking 26th overall. In particular, Slovakia’s health insurance affordability was below average (19th), despite its relatively low cost, with poor levels of choice (25th) and access to new treatments (26th).

This article is part of the FREOPP World Index of Healthcare Innovation, a first-of-its-kind ranking of 31 national health care systems on choice, quality, science & technology, and fiscal sustainability.

Science & Technology

Overall, Slovakia ranked 30th in science and technology. Slovakia’s contribution to scientific discoveries (30th) and medical advances (25th) ranked in the bottom quartile. A relative bright spot: Slovakia ranked 12th in adoption of health information technology.

Fiscal Sustainability

Slovakia ranked above average in the WIHI rankings (14th) for fiscal sustainability, largely due to the low cost of care in the country, with consistent scores across the core elements: national solvency (13th), public health care spending (16th), and growth in public health spending (12th).

ABOUT THE AUTHORS
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Resident Fellow, Health Care