Slovakia: #26 in the 2020 World Index of Healthcare Innovation
Slovakia suffers from limited health insurance choices and poor health outcomes.
By Gregg Girvan and Avik Roy
Introduction
Slovakia ranks 26th in the World Index of Healthcare Innovation, with an overall score of 41.36. Slovakia performed strongest in Fiscal Sustainability (#11, 59.80), owing to its low cost of care.
On the other hand, Slovakia performed poorly in Science & Technology (#23, 27.46) and Quality (#29, 43.70) 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 Austro-Hungarian 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 29th overall. Matching that overall ranking, Slovakia ranked 29th on measures of detecting and addressing preventable disease. Likewise, Slovakia’s patient-centered customer service ranks in the lower quartile (27th), and its health system infrastructure ranks in the bottom third (22 of 31).
Choice
Slovakia struggles to provide quality choice options for its citizens, ranking 25th overall. In particular, Slovakia’s health insurance affordability ranked in the bottom third (20 of 31), and its offering patients the freedom to choose health care services (25 of 31).
Science & Technology
Overall, Slovakia ranks 23rd in its contribution and access for patients in science and technology. Slovakia’s contribution to scientific innovation (30th) and medical innovation (21st) ranked in the bottom quintile and third of the WIHI analysis, respectively. One bright spot in Slovakia’s health system dealt with its EHR adoption rate, ranking 9thoverall.
Fiscal Sustainability
Slovakia ranked in the top third of the WIHI analysis (11th) in fiscal sustainability. In particular, Slovakia’s control of the growth of its health care spending as a share of GDP since 2010 ranked it 5th overall. Nonetheless, its debt-to-GDP ratio was relatively high (16th) compared to the other 31 countries in the analysis. Likewise, public health spending per capita ranked the same (16th).
