On September 29, 2021, the Government of the Slovak Republic approved, by Resolution No. 561/2021, the Draft Act on the Categorization of Inpatient Health Care and on Amendments to Certain Acts, as amended (hereinafter also referred to as the “Act”). We will briefly outline the objectives of this legislation, the content of the categorization of inpatient healthcare, the planned hospital levels, and other changes proposed in the Act in the following article, and we will subsequently inform you of its final form.
Objectives of the Proposed Legislation
The main objectives of the Act are to improve the quality of inpatient care and achieve better patient outcomes, stabilize resources (higher quality with the same resources, reducing staffing needs by optimizing the delivery of inpatient care), and increase hospital staff satisfaction.
Another significant objective is to ensure an adequate number of physicians to sustain and strengthen primary outpatient care in the Slovak Republic, as the Slovak Republic currently has the fewest general practitioners per capita in the European Union, and the high average age of these physicians also poses challenges. To this end, the Act introduces a basic definition of districts with a shortage of primary outpatient care, and the Recovery Plan will allocate 10 million euros to be used for paying a financial contribution to support the arrival of new doctors, as well as to support providers who create new jobs in districts with shortages.
The new concept of institutional healthcare is intended to increase patient safety and ensure high-quality and accessible healthcare. Better quality of healthcare is to be ensured by concentrating specialized healthcare and certain types of medical procedures (particularly invasive surgical procedures) in hospitals where healthcare professionals have the necessary skills and experience to provide them. This change was necessitated by the current fragmentation of healthcare provision, as there is currently a low level of coordination and cooperation among hospitals, with each hospital specializing in different medical procedures, resulting in many hospitals being unable to provide patients with comprehensive inpatient care. To improve the quality of healthcare, one billion euros will be allocated from the Recovery Plan for the modernization and construction of new hospitals and the purchase of state-of-the-art medical equipment.
Categorization of Inpatient Care
The categorization of inpatient care, which will be updated annually, is intended to ensure the creation of an optimal hospital network (OSN). Inpatient care will be divided into 5 levels (community, regional, comprehensive, tertiary, and national), with the criteria for determining the appropriate level being the complexity, frequency, and the need for proximity of inpatient care to the patient. Institutional care will also be divided into programs and medical services, and a list of mandatory and optional programs and medical services will be defined for each hospital level. As part of the categorization of inpatient care, specific requirements will also be defined for material and technical equipment, staffing, minimum annual procedure volumes that a provider or surgeon must perform, maximum waiting times, and quality indicators for the inpatient care provided.
Individual hospital levels
National level - highly specialized care for very rare conditions. There will be only one national hospital in Slovakia, where procedures such as heart transplants will be performed.
Regional level – specialized care for low-frequency conditions. This includes, for example, highly complex oncological treatment, cardiac surgery, or highly complex neurosurgical procedures. Travel time to a regional hospital should be within 90 minutes.
Comprehensive level - comprehensive acute and planned care at the regional level, e.g., acute severe trauma or moderately complex oncological surgical procedures. The travel time for emergency medical services to a comprehensive hospital should be within 1 hour.
Regional level - standard acute and planned care at the regional level. The regional hospital will serve residents of two to three nearby districts, and the hospital should be accessible within 30 to 45 minutes of the patient’s residence. At this level, basic surgical procedures, standard inpatient care, pediatrics, and obstetrics should be provided, as well as planned procedures such as joint replacements.
Community Level - follow-up and rehabilitation care, urgent outpatient care, comprehensive outpatient care, specialized care; a community hospital may provide one-day medical care, day care, psychiatric care, and inpatient care.
Regulation of Health Insurance Companies’ Profits
The current Act No. 581/2004 Coll. on Health Insurance Companies, Supervision of Health Care, and Amendments to Certain Acts does not regulate the profits of health insurance companies or the payment of dividends. The aim of the amendment to this Act, which would be implemented by the Act, is to use public health insurance funds primarily to cover healthcare costs, i.e., for the benefit of insured persons. The amendment also aims to prevent the disproportionate return on invested private capital that has been achieved to date. An implementing regulation of the Ministry of Health of the Slovak Republic is thus intended to establish criteria for determining the appropriate optimal profit for insurance companies. The Act also regulates the minimum percentage of collected premiums that insurance companies must use for healthcare.
Health insurance companies consider profit regulation to be unconstitutional and have expressed their disagreement in numerous comments on the draft law.
Decline in Hospital Beds
The Act on the Categorization of Inpatient Healthcare is based on the premise that patients should be treated in hospitals, not just lie there. According to calculations by the Slovak Ministry of Health, by 2030, Slovakia will need only approximately 17,500 acute care hospital beds instead of the current 28,262. By 2030, the number of acute care beds is thus expected to drop by as much as 38%.
In 2019, then-Minister of Health Andrea Kalavská introduced a healthcare reform and the so-called stratification of hospitals; she resigned from her post due to the reform’s failure. Two years later, the Slovak Ministry of Health is attempting to push through healthcare reform once again by creating an optimal network of hospitals. However, this reform is also meeting with dissatisfaction from the general public, who are most concerned about the “closure” of hospitals and having to travel for healthcare to hospitals located tens of kilometers from their homes as a result of the categorization of inpatient healthcare under the Act.
Numerous comments were submitted on the draft Act, both from the public and from the aforementioned health insurance companies, self-governing regions, the Slovak Medical Society, the Health Care Supervision Authority, and other entities. Currently, the comments submitted during the inter-ministerial comment procedure are being evaluated. If the Act is adopted, hospitals would be required to begin full operations in 2024, according to the classification to be issued by the Ministry of Health of the Slovak Republic as of January 1, 2022.
