In order to stabilise paediatric outpatient care in Slovakia and to maintain the functioning of emergency services for children, Minister of Health Michal Palkovič signed a decree concerning the modification of fixed points of outpatient emergency services for children and adolescents, which will enter into force from 1 October.
–The Ministry of Health has long warned about the pediatrician's critical situation and the imminent problems with outpatient emergency services. The aim of the Decree is to set up an effective allocation of personnel capacities as one of the measures to maintain outpatient emergency services for children in the current critical state. We have prepared a number of proposals to stabilise the pediatrician situation and on APS or emergency with detailed mechanisms and procedures, how this will work in practice. We have already implemented some measures; others require legislative changes, for which unfortunately it has not been possible to obtain support in the current Parliament, said Michal Palkovič, Minister for Health.
The aim of transferring fixed points APS is to concentrate doctors into functional teams while at the same time bringing them closer to hospitals to ensure laboratory examinations or imaging methods. Fixed points are approaching hospitals, ensuring the continuity of healthcare provided where necessary.
The adoption of changes was preceded by an analysis of the situation which showed that a third of all APS are operated by a maximum of 10 doctors. At the same time, it pointed to areas where fixed points can be shifted to ensure that the availability of healthcare provided is not only preserved but, on the contrary, improved. The aim is for at least 15 doctors to serve on fixed points.
Without these stabilisation measures, the sustainability of the availability of general outpatient care for children and adolescents is also at risk.
PAccording to the Decree, the network of children's emergency services from the original 61 to 40 until the end of 2024 will be gradually modified in three stages. From 1 October 2023, six fixed APS points will be deleted, which are currently without an operator, as no one has shown any interest in operating them. A further ten points of APS for children should be deleted from July 2024 and the third phase, which is intended to cover five points of APS, is scheduled from November 2024.

Slovakia has long struggled with the lack of primary pediatricians. This segment was several decades on the fringe of interest, without taking the necessary stabilisation measures. The resort has therefore prepared changes aimed at maintaining paediatric offices as well as APS offices for children, due to the lack of paediatrics and their age structure. The average age of pediatricians is currently 59 years. The lack of primary paediatricians has increased significantly over the last two years. It is these doctors, half of whom are in retirement age, who serve in the ambulances during the day and enter emergency rooms in the afternoon, which is a disproportionate burden.
The Ministry of Health has also repeatedly discussed with representatives of the sector and prepared a number of measures which required legislative changes approved by members of the OR, which could not be enforced as Members had not opened the parliamentary meeting. For example: -efficient availability of office hours of outpatient healthcare: the standard 35 hours per week should be filled five days per week, -shortening of office hours of outpatient emergency services to 20 hours,-increase of fees to APS from original 2 € to 5 € and to the UPS from original 10 € to 25 €,-obligation of the self-governing region to ensure that general outpatient care is provided for 5 working days per week.
The Health Department has prepared systemic reform measures by 2030 to stabilise the outpatient system. Their implementation is gradual. In addition to transferring fixed points of outpatient emergency, the Ministry has acceded, for example, to:
- increase the flat rate for outpatient workers by 35%,-reduce the bureaucratic burden by abolishing the issue of certain certificates by pediatricians, for example before camp, skiing etc. (the proposal is currently in the commentary procedure),-re-opening of a resident study for pediatricians (from October onwards up to 53 young doctors could be included).
Support activities, such as the application of the General Health Insurance Agency with the doctor on the phone, the mobile application of the National Institute of Children's Diseases, which will become fully operational from 1 October 2023 or the project of the Society of Primary Pediatrics and Pediatrics to children o.z. www.pediatridetom.sk, will help parents to focus on their children's health problems, when to contact a doctor, whether to seek emergency care or emergency care, etc.