The State System
There are five health insurance companies responsible for the collection of the health insurance contributions and for reimbursements.
The General Health Insurance Company covers the majority of the population. The Common Health Insurance Company is the second largest and both are guaranteed by the state. Citizens are able to change insurance company at any time, but there is little competition between the insurance companies, although more recently insurance companies have attempted to attract people to their funds. There appear to be no identifiable benefits for the public in having such a choice of companies. The money collected by each insurer is paid to the state run General Health Insurance Company for rationalisation.
Health insurance is mandatory for all income-earners. The government pays contributions for those citizens who are exempt for contributing like the unemployed, old age pensioners and people on long-term sickness benefit, maternity leave, job seekers, those on disability benefits and reservists. Employers must register their employees with one of the health insurance funds when a new employee starts work. Employees pay 4 percent of their basic income into the fund, whilst employers pay 10 percent. Employed disabled people need only contribute 2.6 percent of assessed income because the state makes up the remainder. Self-employed citizens must pay the full 14 percent contribution, which is calculated as 50 percent of the income on which they paid tax in the previous year. The minimum wage for healthcare contributions is approximately 91 EUR and there is a top limit whereby you do not need to contribute any more to the insurance funds, which makes this a system biased towards high income earners.
Dependant family members are not covered by the contributions paid by employed or self employed family members.
Foreigners immigrating to Slovakia without jobs must produce proof of private health insurance in order to obtain their residence permit.
The state fund covers most medical services including treatment by specialists, hospitalisation, prescriptions, pregnancy and childbirth and rehabilitation.
Most medical services in Slovakia are free of charge for those who qualify, but some services are only subsidised and citizens must pay part of the cost. Co-payments exist for some prescription drugs, some dental treatment and medical devices. Non-essential treatments like cosmetic surgery, treatment abroad and acupuncture and excluded from cover.
Prescription medicine for those who suffer from chronic illness or those who belong to the medically vulnerable groups e.g. pregnant women, war veterans, diabetics and tuberculosis patients are exempt from all charges. Drugs are divided into three groups, with the first category consisting of essential drugs, which are fully reimbursed by the insurance companies. The second category are partially subsidised and the third group receive no subsidy at all. Appointments with a doctor and referrals to a consultant are free.
Few people take out additional health insurance, which is offered by the five insurance companies. Those that do use it either have no state cover or use it to supplement the state healthcare in areas not covered by the basic care package. Voluntary coverage does reimburse treatment abroad.
Doctors and Health Centres
Doctors fall into one of three groups in Slovakia; general practitioners for adults, general practitioners for people under eighteen, gynaecologist-obstetricians. GPs provide basic examinations, diagnoses, preventive care, prescriptions, referrals, home visits and emergency health services.
GPs tend to work in one man practices, which are predominantly private. However, private doctors rent their rooms and equipment from the state facilities and make contracts with the health insurance companies. Most doctors employ at least one nurse in their practice. Citizens can register with the doctor of their choice and have the right to change their GP every six months. Most people select their GP according to their proximity to the workplace. People seeking state medical care must make sure that their doctor is contracted into the state scheme through one of the insurance companies. Doctors in Slovakia still take under-the-table payments which are not authorised by law. Doctors are obliged to inform their patients about the possibility
of receiving drugs free of charge.
Many doctors rent their rooms from the polyclinics and health centres. These facilities are responsible for outpatient healthcare. Medical services provided include, general practice, maternity care, child healthcare and dental care. They also provide emergency medical aid as well as laboratory, radiology, and other diagnostic services.
Health centres are staffed by qualified doctors and nurses. Some polyclinics are private.
Waiting times to see doctors vary and it is recommended that you make an appointment in advance. If you need urgent help, you may go to the doctors surgery on speculation, but be prepared for a long wait.
Many patients ignore their GP as the first point of contact and self refer to specialist doctors. Consultants are senior doctors who have completed a higher level of specialised training. GPs refer patients to a consultant if he believes that a patient may need specialist help and diagnosis. There are numerous specialist fields of medicine in Slovakia like gynaecology, oncology, paediatrics and dermatology. Many consultants work out of the state facilities.
There are 44 hospitals in Slovakia and they are managed by the regions. Hospitals have been under-funded in recent years and are in need of new equipment and technology. Sometimes hospitals have been unable to purchase certain drugs and medical devices, although the situation is improving. Hospitals and clinics exist in all major towns and cities. Patients are admitted to hospital either through the emergency department or through a referral by their doctor. Once a patient is admitted treatment is controlled by one of the hospital doctors. There is a waiting list for some non-emergency treatments and services.
Emergency care is available free for everyone including those without state health insurance. However, once your condition is stabilised they will want proof of your insurance status. Emergency treatment is provided at the emergency room of all hospitals. Emergency departments are open non stop all year. You may use their services if you need immediate attention, or if your GP refers you to them, or if there is no GP service available.
Most doctors and specialists are private practitioners in Slovakia. They operate out of rented offices in public facilities funded by the doctors themselves and by additional voluntary private insurance contributions. Private health is only used by a limited percentage of people, often as a top up to the basic state healthcare and to cover them for the services deemed non-essential.
Dental care in Slovakia is mainly private and dentists are paid on a fee for service basis. Some dental treatment is available through the state healthcare system, but it only covers routine visits and check-ups. Citizens must pay themselves for more detailed dental treatment like crowns and bridges.
Dispensing chemists sell medicines and only doctors and consultants can prescribe medicine in Slovakia. Prescription medicine is only available from a qualified and registered chemist or from a hospital pharmacy. Non-prescription drugs are priced higher than prescription drugs. Under this system, you may pay less for a packet of aspirin if it has been prescribed by your doctor. Costs for prescription drugs are reimbursed through the national health system.