Improved quality of health care, better working conditions, stabilisation of health professionals or fair assessment of health professionals are among the priorities of the health sector. Representatives of professional organisations, as well as employees' representatives through their trade union leaders, shall be informed of the steps taken or planned in joint negotiations. Over the past few years, health departments, hospitals, pay, or outpatient networks have been at the heart of the disinterest of previous governments. Many patients had to wear their own cutlery, towel or toilet paper to the hospitals, health care professionals had to buy their work clothes with their own money, media informed about mold walls and substandard conditions (space, technical, material), only a fraction of what was needed in modernising hospitals, construction of new state hospitals stopped at a dead point for almost 3 decades and Slovak health became a symbol of decline. The media, experts, and analysts reported major health neglect and impending problems. However, medical trade unionists felt that only the weakest bit was biting. Over the past decade, nurses and midwives took the courage to point out the condition in hospitals when they gave mass testimony in 2015. The then government turned its back on them and many of them remained out of work, moreover, unemployable on black lists, and the decline in health continued.
Following the 2020 elections, health has become an absolute priority for the government. Despite the global pandemic, the Slovak Ministry of Health launched a reform process which has been unprecedented in Slovakia since 2004 at least. In addition to the reform of the hospital network, the drug revolution was successful, new conditions were set for the care of long-term sick patients, the process of hospital discharge was carried out and the construction of two new top university hospitals in Bratislava and Martin started.
Despite these reform efforts, it is not possible, within a few months, to eliminate the consequences of the reprehensible inaction of previous guarantees, which are now reflected in the shortage of health workers, poor working conditions, the lack of equipment or the overall state of hospitals.
Last week, the Minister of Health stated publicly that the LOC will be familiar with the current state of play of the tasks, which are also based on the requirements of trade unionists. The document will be completed and sent to LOP management within the next few days.
In order for the professional, but also the general public to have an objective view, we publish a quick overview of the steps already implemented or planned, which are also contained in the requirements of the LOP.
1. Ensure payments from health insurance companies to hospitals so that health care facilities are covered by all costs related to adequately provided healthcare. Setting up insurance payments is only possible provided the criteria are clearly set. The current system of lump-sum payments for institutional care is not appropriate and sustainable in the long term, as it does not encourage the hospital to behave efficiently and to provide patients with all the necessary services as soon as possible. This was the reason why DRG implementation started in Slovakia. Unfortunately, the implementation process since 2011 under the authority of the Health Care Supervisory Authority is very slow. This was the reason why last year the competence of completing the location of the DRG system to the Ministry of Health of the Slovak Republic was transferred.
- The priority is to develop and set up a methodology for the control of medical and economic data, the actual data purification and calculation of Relative Weights, which are the basic condition of a fair DRG system.
- In addition, it is necessary to increase the level of communication regarding the quality of reported data and to provide relevant feedback to institutional healthcare providers, which together would lead to the revision of the disputed parts of the methodology of the Calculation Guide in order to ensure quality data for the cultivation of the DRG system in Slovakia in the coming years.
The Ministry of Health has been working intensively since last year to make the DRG system, including Slovak relative weights, fully operational since 1.1.2024.
MUDr. Peter Zimmerman.
2. Increase the number of doctors, nurses and midwives to ensure quality healthcare for the patient, guarantee these numbers by law and introduce criminal liability in case of non-compliance. The proposals for the historically highest increase in the salaries of health professionals, which have already been introduced to some associations, are just a first step towards stabilising medical staff in hospitals. In parallel, the Ministry is preparing a package of other measures to keep and attract new health professionals into the system:• The Ministry of Health of the Slovak Republic prepared and sent a draft decree on minimum requirements for personal security and MTZ of outpatient health facilities (term for comments by 5.9.) Article 2
- in preparation is a draft decree on minimum requirements for staffing and material-technical equipment of constitutional health institutions, then the proposal will be submitted for comment to the main professional and professional organisations (term for commenting October 2022)
- Work is underway on the National Strategy for the stabilisation and management of human resources in health by 2030 (October 2022 presentation date)
- preparation of the electronisation of sister documentation (sister tablets) so that they can record the patient's health information in the electronic system (expected start date October 2023)
- The Ministry of Health has started checking compliance with personnel standards at individual departments in health institutions (in process)
- a change in the competences of nurses, practical nurses and medical paramedics (expected date of completion of the legislative process October 2023) is being prepared. MUDr. Martin Zakucia is a member of the working group for Loz.3. Abolish humiliating and discriminatory non-monetary performance.In this case the amendment of Law No 595/2003 is necessary Z.z. on income tax. The law is in the department of finance. The subject matter was discussed with doctors' representatives.
4. Ensure medical faculties so that they can produce more quality Slovak doctors.Following the meeting held with representatives of the Slovak Republic, the Ministry of Health of the Slovak Republic proposed to increase the number of admitted students of the first year of the field of study general medicine.
MUDr. Martin Zakucia is a member of the working group for Loz.5. Reform the education of young doctors. The duration and place of preparation, flexibility and accommodation of educational institutions need to be reviewed. Clear identification of the person responsible for the management of younger colleagues with their adequate mentoring. The Ministry of Health has amended two legislative standards in the field of further training of health workers by Act No 67/2022 Coll. (effective as of 15 March 2022) and Government Decree No 95/2022 Coll. (effective as of 1 April 2022) . The changes adopted have made the process of further training of healthcare professionals more effective:
- the possibility of including healthcare professionals in specialisation studies and certification training throughout the year
- the establishment of deadlines for the inclusion of a health professional for the employer, self-governing region, educational establishment, educational establishments are obliged to write the final specialization exams several times a year
- the possibility of accounting for professional experience prior to inclusion in the specialisation study, the possibility of accounting for foreign professional experience in the specialisation study, the possibility of accounting for health performances beyond the specified weekly working time and others. The legislative process currently includes the amendment of Decree-Law No. 12422/2010-OL laying down minimum standards for specialization courses, minimum standards for certification courses and minimum standards for continuing learning programmes and their structure. Its content is the innovation of minimum standards in the field of mental health (psychotherapy, clinical psychology, advisory psychology, occupational and organisational psychology), adding new minimum standards in the field of protection, promotion and development of public health, radiation protection, gynaecological urology, palliative medicine, algesiology and angiology, rheumatology and others (in total more than 70 programmes). In the process of creation, the new legislation is generally binding, setting minimum standards for specialization and certification programmes in line with new trends in individual medical fields. As part of the development of innovative minimum standards, inter alia:
- Reconsidered duration of specialization fields
- the scope of compulsory professional experience in individual workplaces. This will be a comprehensive innovation of minimum standards in all health professions, representing by its content and scope material with about 280 minimum standards in a range of approximately 800 pages of text. Its preparation will require the cooperation of the Accreditation Commission of the MZ SR for further training of health workers, educational institutions, professional organisations, professional companies and other experts in the subject.
(approval process in the Accreditation Commission of MZ SR for further training of health workers December 2023, conclusion of the legislative process September 2024 MUDr. Martin Zakucia is a member of the working group for Loz.
6. Do not disturb the hospital departments until there is a relatively increased staffing situation in hospitals in those departments that are supposed to take care of the decommissioned departments or hospitals. No reform can be undertaken without the provision of additional medical personnel. The additional burden of overburdened health professionals cannot be contained.
Decree of the Ministry of Health of the Slovak Republic on the classification of institutional health care:
- prepared in cooperation with expert working groups
- approved by the Categorisation Commission, in which all relevant labour and professional associations and companies are also represented
- its form is the result of seeking and finding mutual compromises. Timetable for the preparation of the classification of hospitals:
Term Role Status
to 01/2022 Appointment of a classification panel for institutional care and 64 expert working groups met
to 03/2022 Preparation of the evidence for the categorisation of CPCs in the expert working groups met
to 04/2022 Data collection from health insurance companies for network evaluation needs met
to 04/2022 Preparation of a questionnaire for hospital preparedness to the UN met
Until 05/2022 Approval of the categorisation of the CPC in the Categorisation Commission met
to 06/2022 Preparation of the decree and launch of the legislative process to the HR on the categorisation of the CPC met
to 06/2022 Collection of data from hospitals regarding UN preparedness met
to 09/2022 Preparation of analytical documentation for the design of the first network of hospitals
Up to 12/2022 Issuing decisions on the classification of hospitals and the first network of hospitals
Up to 12/2022 Network evaluation methodology
to 04/2033 Collection of suggestions for updating the categorisation of the PSC
to 04/2033 Collection of applications for inclusion, modification or exclusion from the hospital network
to 08/2023 Second categorisation of institutional care
to 09/2022 Issuing decisions on the classification of hospitals on request
- increase the coefficients on the basis of which the basic wage of health professionals is calculated
- coefficients are increasing on the basis of years worked.
(Law effective date 1.1.2023)
8. Time of maternity and parental leave for the purpose of remuneration evaluation to count to the time of professional experience. In parallel with the preparation of the proposal for a new method of calculation of salary evaluation of health workers The Ministry of Health of the Slovak Republic also analysed the possibility to count the time of maternity and parental leave to the years of work.
After assessing the current legislation, the Ministry notes:
- time of maternity and parental leave cannot be counted against the period of professional experience
- professional practice is defined by law as the exercise of professional specialised or certified work activities by healthcare professionals
- i.e. the legislation contains a special provision for professional practice which does not automatically identify the professional experience of a healthcare professional with the period of employment or differentiates between professional experience and the period of employment.
The forthcoming legislation will therefore provide for the method of crediting the years worked, including maternity and parental leave for remuneration purposes.
(the law's effective date during 2023)