Slovakia: #28 in the 2022 World Index of Healthcare Innovation
Slovakia suffers from limited health insurance choices and poor health outcomes.
By Gregg Girvan, Grant Rigney, and Avik Roy
Introduction
Slovakia ranks 28th in the 2022 World Index of Healthcare Innovation, with an overall score of 39.24. Slovakia ranked 29th in 2021 and 26th in 2020. Slovakia performed best in Fiscal Sustainability (13th), owing to its relatively low cost of care.
On the other hand, Slovakia performed poorly in Science & Technology (30th) and Quality (31st) 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 healthcare system similar to the one installed by Chancellor Otto von Bismarck in Germany.
When Czechoslovakia gained its independence in 1918, following the dissolution of the 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). In 1952, the ÚNP was replaced by a Soviet-style socialist system, which was similar to that of the British National Health Service.
After the dissolution of Czechoslovakia in 1993, the Slovakian government reinstated the Bismarck-style system. By 1997, there were 13 private insurers, though today only four still stand after a number of mergers.
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 can exclude drugs from coverage. The government also sets 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 to deliver high-value healthcare, ranking second-to-last in Quality (31st) overall. Matching that overall ranking, Slovakia also ranked second-to-last on measures of preventable disease (31st). Likewise, Slovakia’s patient-centered care ranks in the lower quartile (23rd), and its health system ranks in the bottom third in infrastructure (28th). Like many eastern European countries, Slovakia largely avoided the first wave of COVID-19 fatalities in the spring of 2020, but was among the worst-hit countries during the winter of 2020-21. Ongoing pandemic preparation in Slovakia has waned, leaving them ranked last (32nd) in pandemic preparedness.
Choice
Slovakia struggles to provide good health care options for its citizens, ranking 17th in Choice. Despite this, Slovakia’s affordability of health insurance was well above average (6th), primarily because of its relatively low cost. However, poor levels in freedom to choose health services and access to new treatments leave them ranked 25th and 17th in these measures, respectively.
Science & Technology
Overall, Slovakia ranked 30th in Science and Technology. Slovakia’s contribution to scientific discoveries (29th) and medical advances (26th) ranked in the bottom quartile. Contrasted to the previous year’s 12th place rank, Slovakia ranked 21st in the adoption of health information technology.
Fiscal Sustainability
Slovakia ranked above average for Fiscal Sustainability (13th), largely due to the low cost of care, with improving scores across the core elements: national solvency (16th), public healthcare spending (16th), and growth in public health spending (3rd).
