Limiting the effects of strict budget consolidation measures, Slovakia’s Parliament greenlit an additional €112 million for healthcare workers’ wages. The Health Ministry and the unions have still not reached a compromise – the crisis turned into multi-issue negotiations.
Parliament approved an amendment in a fast-tracked legislative process, ensuring that the salaries of nurses, midwives, paramedics, and other healthcare workers are set to increase over the next two years as initially planned, before the adoption of consolidation measures.
The €112 million boost, signed into effect by President Peter Pellegrini on Thursday, also includes an annual salary increase for doctors. However, it is set at 6.4%, not the 9.7% outlined in the 2022 memorandum signed by the government and unions.
“This is a good foundation for further negotiations aimed at stabilising Slovak healthcare and keeping patients out of disputes between the government and doctors,” President Pellegrini declared.
However, an agreement between the government, the Health Ministry, and the Medical Trade Union Association (LOZ) has yet to be reached, with a key meeting scheduled for Friday.
The 6.4% increase is considered insufficient by doctors, who demand the originally agreed raise while calling for additional conditions and systemic changes agreed upon in the memorandum.
More than 3,300 doctors’ resignations have been filed at the time of writing, representing just over half of all doctors in Slovak hospitals. These resignations will go into effect in January.
“If an agreement is not reached in time, by January, even acute healthcare may not be properly provided,” head of the Association of Slovak Hospitals Marián Petko, warned on Thursday.
This week’s talks
A newly established working group to address hospital financing structure and agreements between hospitals and health insurance companies got off to a rough start on Monday. As agreed last week, representatives from the Health and Finance ministries and LOZ should have been present.
Much to the union’s dissatisfaction, nobody from the Finance Ministry attended the meeting.
On Tuesday, the simplification and better accessibility of young doctors’ training was on the docket, with the discussions on the memorandum’s points wrapped up. The Ministry is now expected to present a progress report on fulfilling the points at the next meeting on Friday, according to Visolajský.
Doctors have not yet withdrawn their resignations, insisting that the government address the problems in healthcare first.
“Hold your positions,” Visolajský wrote in a centralised e-mail addressed to doctors seen by Euractiv.
Last week’s deliberations
During last week’s meetings, selected points of the 2022 memorandum were discussed.
The agenda included talks about compliance with the labour code, hospital staffing regulations, and ensuring an adequate number of nurses in Slovak hospitals. LOZ also wants to have a say in the location of the next national hospital.
A portion of the meetings was a dialogue dedicated to education at medical faculties. “We disagree with the constant increase in the number of foreign students at medical faculties,” Visolajský stated.
He added that the increasing number of international students compromises quality, as the exhausted capacities of medical faculties leave insufficient focus on Slovak students.
A tale of two sectors
Visolajský claimed that resignations were filed from all sectors. However, the number of resignations from state hospitals and hospitals operated by the two biggest private actors in healthcare, AGEL and Penta Hospitals, is strikingly disproportionate.
“The situation remains unchanged within the Penta Hospitals network. There are 42 resignations in eastern Slovakia, which is less than 3% of the total number of hospital doctors within the network,” spokesman for Penta Hospitals Tomáš Kráľ confirmed to Euractiv.
“In the healthcare facilities within the AGEL network, we are recording doctor resignations; however, they are below 1% of the total number of doctors employed in the AGEL network in Slovakia. Therefore, we can assure patients that healthcare services in our facilities continue to be provided in a standard manner,” deputy spokeswoman for AGEL Jarmila Šefčíková explained to Euractiv.
Confusion and chaos reign
One key demand of the medical unions is that Fico’s government commit to not converting hospitals into joint-stock companies.
The idea was floated by several ministers and appeared on the government’s radar as Slovakia faces mounting state hospital debts, significant payment delays, and the looming threat of daily fines from the European Commission following a Court of Justice ruling, all of which put pressure on budget consolidation efforts.
Only five Slovak hospitals are joint-stock companies established during the Dzurinda II government (2002-2006). The majority function as contributory organisations under the Health Ministry or regional management.
The unions claim the transformation could lead to the subsequent privatisation of hospitals and the strengthening of private influence in healthcare.
While PM Fico and Minister Kamil Šaško distanced themselves from the idea, the State Secretary at the Finance Ministry, Radovan Majerský, hinted on Tuesday that the transformation is still on the table, which outraged the unions.
What would it mean
The intervention would not change the state’s ownership of hospitals but would ensure more oversight over financing, which has become a chronic issue within the health sector.
MP Dr Tomáš Szalay highlighted that state hospitals are currently not required to undergo any public audits or issue annual reports, leaving no insight into how they manage their finances.
“A joint-stock company, on the other hand, is obligated to maintain standard accounting practices and undergo external audits, ensuring that the funds are subject to public and transparent oversight,” he said during a press conference.
MP Szalay explained that the intervention is not a silver bullet but a step in the right direction, and he does not understand why the government wants to abandon a good idea.
“A joint-stock company allows hospitals to follow modern management practices, moving away from political interference,” he added.
According to the Institute for Economic and Social Reforms, transforming state hospitals into joint-stock companies carries the potential for systemic change that could bring greater order, transparency, and accountability in the management and operations of these facilities.
However, the change in legal form would need to go hand in hand with implementing additional hard budget constraints.
Euractiv asked the Ministry to comment on where the Minister stands: “Negotiations are still ongoing with representatives of the Medical Trade Union Association regarding the individual points of the 2022 memorandum. The Health Minister will inform the public about the details in due course.”
Minister Šaško is expected to elaborate on the status of hospitals on Friday.
PM steers clear
Prime Minister Robert Fico maintains that healthcare and management of this sector are not PM-level issues. He does not interfere in the negotiations, leaving the Minister to take the heat.
“I neither see nor hear any reaction from the Prime Minister. The PM talks about how healthcare is not a prime ministerial topic, saying he cannot deal with everything,” MP Oskar Dvořák said during a press conference.
“So I am asking him directly: what is a prime ministerial topic? And what needs to happen in healthcare for it to become one? Especially when we have hospitals on the brink of collapse,” he continued.
It is the hope that kills you
Šaško remains hopeful that the situation will be resolved and doctors will not leave, despite the 2-0 track record the medical unions have with Slovak governments.
“I come from an honest family of doctors, and I do not believe that a Slovak doctor would abandon a Slovak patient,” the Minister said.
“I simply do not believe that because I know that doctors are decent people, and the interests of patients come first for them, just as they do for me. How we ensure this will be a matter for discussion,” Minister Šaško added.
[Edited by Vasiliki Angouridi, Brian Maguire]
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