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480 Economic crisis, health systems and health in Europe: country experience
User charges
• Introduction of an annual cap on OOP payments for drugs for vulnerable
groups (€30 for disabled or older people, €45 for people with low income)
(2011).
Changes to health service planning, purchasing and delivery
Prices of medical goods
• Introduction of reference pricing (2009–2010) and subsequent adoption of
stricter benchmarking for drug pricing, making its reference pricing the
second lowest in the EU (2011).
Salaries and motivation of health sector workers
• Increase in salaries of nurses and hospital physicians through the setting of
national minimum wages (2011) (but increase in nurses' salaries is currently
being challenged in the Constitutional Court by the Slovak Chamber
of Physicians).
Payment to providers
• Started work on DRG implementation in 2011 in order to increase efficiency
but the project was postponed to 2016.
• Introduction of mandatory publication of contracts in the public sector to
allow better monitoring and public inspection of procurement of goods and
services in the health system (2011).
Overhead costs: restructuring the Ministry of Health and purchasing agencies
• Two state-owned health insurance companies (Common Health Insurance
Company and General Health Insurance Company) merged (2010). The
aim was to address an acute lack of funding leading to delayed payments
to pharmacies and providers. The merger secured €65 million from the
state budget and another approximately €33 million from the financial
reserves of the Common Health Insurance Company.
• Introduction of a formula for the calculation of the limit of health
insurance companies' administrative costs (2011).
• Health insurance companies reduced the number of their staff by 10%
between 2010 and 2011.
Provider infrastructure and capital investment
• Reduction (by up to 10%) of hospital beds by the largest health insurance
company, the state-owned VšZP (2011). The optimization of the hospital
care network was designed to promote facilities with better quality
outcomes, to enhance effectiveness and to support day surgery.