Bad state of public healthcare - whose fault is it?

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?