Bad state of public healthcare - whose fault is it?

Given the state of public healthcare in Slovakia, it sometimes seems like we are back in the Soviet era. The buildings are old, the equipment is dated and apparently no renovations are planned. More than twenty years after its independence, how can Slovakia account for such degradation of its public healthcare?

Renewal from the inside is inevitable

07/02/2013 - 16:13
The first thing that should be emphasized when talking about public healthcare in Slovakia, is the extent to which the sector is managed by public authorities. Can a state of five million people without extremely abundant natural resources invest enough in public healthcare? Or is it time to change this system?

The organization of the health sector in Slovakia is modelled after the socialist system of the Soviet times, taking as an example an era, when the state was its sole manager. Therefore, people and especially the elderly are struggling to accept the fact that it is no longer the state that covers all costs related to healthcare. The question is whether a country which has moved on to a capitalist system can still cover the integrity of the costs. Keeping in mind that the medical sector is very little privatized in Slovakia, all measures attempting its privatization are perceived very negatively by the Slovak population since people of course see them as an increase in their own spendings. However, such reforms are, to some extent, inevitable.

In addition, we must not forget that in Slovakia, even twenty years after the liberation from Soviet domination, some problems inherited from the Soviet era seem to persist. One of these legacies is the level of corruption, which remains quite high. Thus, the money collected through taxes is not used efficiently, which raises the question of the effective allocation of resources. Therefore, with such a degree of financing and management of public healthcare by the State, everything essentially depends on the incumbent executive power. This situation reflects the problems evoked by the public choice theory, a Europe-wide debated issue.

Comparison with other countries: un unjustified comparison

Slovak doctors and other workers in the medical sector often highlight that they are paid less than in other countries. Even though a fact is a fact, they match their standards of comparison to neighboring countries, such as Austria and the Czech Republic, sometimes even to Germany. However, we should perhaps start from the other end of the story and compare their GDPs first. Is it realistic to expect from Slovakia to inject as many resources in public healthcare as countries whose GDP exceeds its own by far? In addition, referring to wages abroad, we should not forget that the costs of living are also higher there, which ultimately reduces the gap between Slovakia and those countries.

Thus it is possible to say that even if the economic catch-up of Slovakia has been impressive in recent years and has not slowed down even during the crisis, the country still lags behind its Western neighbors. Therefore, it is not justified to compare the salaries of doctors abroad and in Slovakia.

Increasing salaries: a counter-productive measure

If doctors and medical staff are ready to fight for higher wages, it seems that such outcome would hurt them even more. Although wage growth seems at first a victory for underpaid staff, this is the same staff who later pays for it. Even in the context of the current economic and financial crisis affecting the whole of Europe, a gradual increase of their salaries was granted to them under the government of Iveta Radicova. However, since 2009, the rise by one third of their wages has caused many lay-offs of doctors and medical staff. For example the Trnava hospital had to lay-off 13% of its employees, which is directly reflected in the quality of their services.

Since hospitals pay their own employees, allocation of higher wages is a reallocation of resources given to hospitals and does not solve the problem, but makes it even worse. Doctors and medical staff are losing their jobs parallel to the deterioration of the quality of services. What other conclusions can we draw when hospitals are understaffed and remaining staff has to work even more?

This article deliberately presents only one of the many existing points of views of this contorversial subject. Its content is not necessarily representative of its author's personal opinion. Please have a look at Duel Amical's philosophy.

Slovak public healthcare mismanaged by the State

07/02/2013 - 16:13
The state of the Slovak healthcare is always bad. Medical staff are poorly paid thus they are unhappy, just like patients in general. The old hospital buildings are a disaster... All this because the state is not able to make healthcare a priority and properly manage its funding.

Health and Education are probably the most important areas managed by the state. Paradoxically, in Slovakia, healthcare and education does not seem to be sufficiently valued by governments in general, since their situation has not improved for many years. Regarding public healthcare, it is obviously a very sensitive issue, because health is important for everyone, especially when difficulties arise. Thus medical care and their low quality concernes everyone, but above all those citizens who accuse both the state and the medical staff. If both are really at fault, it is still the state that is more responsible since it manages and finances the system.

Medical staff on strike

Medical staff consists of people who are supposed to save lives and to do so they must be educated. From this point of view, it is shameful that they earn so little in comparison with other professions requiring long studies and compared to their colleagues abroad. It is not surprising then that the best doctors leave and those who remain demande the revaluation of their salaries. That was at the origin of the doctors' strike of 2011 which resulted in a gradual increase of their salaries given to them by the government of Iveta Radičová, that is to say by the Health Minister, Ivan Uhliarik. It was only a relative success, yet nurses and midwives were also inspired by it and have launched a strike in late 2012. However, the government has meanwhile changed and the Ministry of Health, with the Minister Zuzana Zvolenská (independent politician in Robert Fico's socialist government of SMER) at its head have given them more difficult this increase of wages. These movements occurred during the years of the crisis, where employers have fired a nurses or forced them to sign amendments to their contracts, thus making them mere administrative employees. The State has only responded to this slowly and inadequately.

Lack of money

Once again it must be emphasized that the source of these problems lies in the mismanagement and financing of the sector, which is in the hands of the state. The fundamental problem is the misallocation of the scarce resources set aside for healthcare, especially for hospitals. Not only is the staff poorly paid because hospitals lack money, but also, most of the buildings are in a poor condition and continue to deteriorate because the state does not have the means to invest in them. However, lack of funding is at times only an excuse.

What is the solution?

The question of whether the state will be able to resolve the situation once and for all remains open. Even Mr. Zvolenské has recently said that not more money should be spent on healthcare, instead the already available resources should be better utilized and invested. But stating the obvious is one thing, taking action is another. Efficiency is at the origin of the proposals for privatization of hospitals. That could be one of the solutions. Privatization would mean investment which would also bring about reparations, efficiency and probably a real improvement of the conditions and of the situation in general. However, no one knows if there are investors who would want to take over indebted hospitals, how many hospitals would be affected and to what extent the state is open to privatization.

This article deliberately presents only one of the many existing points of views of this contorversial subject. Its content is not necessarily representative of its author's personal opinion. Please have a look at Duel Amical's philosophy.

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