Shocking Slovak healthcare audit report says system is ‘a seriously ill patient’

The Slovak Supreme Audit Office has published a scathing report describing the Slovak health system as a seriously ill patient. The shocking analysis is the latest in a series of damaging healthcare events plaguing Robert Fico's government.

When the Health Ministry and the financial management and administration of healthcare facilities were put under the microscope by the Slovak Supreme Audit Office (NKÚ), they uncovered financial issues going far beyond late payments and the most recent CJEU ruling.

NKÚ's audit from 2018 to 2023 examined developments in five areas where shortcomings had been identified in the past: the financial management of healthcare facilities, concession contracts, costs associated with building maintenance, public procurement, and strengthening management accountability for the results achieved.

The findings were far from satisfactory.

"Slovak healthcare is still a seriously ill patient, kept alive by partial solutions, but comprehensive measures from the Health Ministry, which would lead to its stabilisation, have not yet been implemented," NKÚ stated in the report.

Chronic debt accumulation

According to NKÚ Vice Chair Henrieta Crkoňová, the results of previous audits pointed to unrealistically set budgets for healthcare facilities and systemic changes that would encourage stabilisation have not been implemented.

"Management of university and faculty healthcare facilities remains a long-standing problem. These institutions continue to generate losses, incur debt, and settle invoices with significant delays," Crkoňová added.

Based on the identified shortcomings, NKÚ recommended adopting effective measures with clearly defined tasks and responsibilities to improve the management of subordinate healthcare facilities. However, the audit revealed that these recommendations have not been translated into systemic changes, and the deficiencies highlighted in previous audits remain unresolved.

The debt situation repeatedly reached a critical point, making it necessary to provide additional resources to healthcare facilities as a one-time measure. The response was debt relief, carried out five times since 2003, totalling over €2.2 billion.

"It was meant to be an extraordinary tool of the state to stabilise the situation. It was not a systemic solution, and as developments have shown, the situation did not change. Now a sixth hospital debt relief is in the pipeline," the report warns.

Healthcare facilities rid themselves of old debts but simultaneously generated new debts since their revenues were insufficient to cover the increasing costs of salaries, medications, or medical materials.

Moreover, the continuous accumulation of debt and overdue liabilities increased the operational costs of healthcare facilities with penalties and contractual fines.

By the end of 2023, the debt of the 13 largest hospitals amounted to over one billion euros. 

Lack of vision, stability, and continuity

The Supreme Audit Office also pointed to personnel instability at the Ministry. During the audited period of 2018–2023, the Ministry experienced nine different ministers, and the organisational structure was significantly altered 36 times.

As a result, the audit found that the continuity in task fulfilment was, in some cases, what posed challenges to implementing potential healthcare reforms and stabilising the sector.

Warnings and recommendations

NKÚ recommends that the parliamentary health committee urge the Slovak government to commit the Health Ministry to present a plan for achieving sustainable financial management in healthcare.

The Office also instructed the Ministry to adopt measures to address the identified deficiencies and to submit a report on their implementation.

If no action is taken, the lack of financial resources will reoccur every year, and healthcare services will become increasingly inaccessible due to the shortage of doctors and nurses, NKÚ warns.

"The goals that we, as a country, have committed to in areas such as life expectancy, preventable mortality, and others, will be very difficult or only partially achievable with the Ministry's unchanged, unsystematic management," the report states.

Next steps

"The audited entity submits measures to NKÚ within the agreed-upon timeframe. How the proposed measures are implemented is up to the audited entity (e.g., whether it establishes a working group or proceeds in another way)," NKÚ spokeswoman Daniela Bolech Dobáková confirmed to Euractiv.

"The deadline for submitting the adopted measures in this case has not yet passed. By adopting them, the Ministry of Health of the Slovak Republic will commit to addressing the identified deficiencies," she continued.

"The Ministry of Health communicates and cooperates intensively with the Supreme Audit Office and provides maximum cooperation. Following the report and the findings of the NKÚ, the Ministry is preparing proposals for measures which will be submitted to the NKÚ within a set timeframe," the Ministry told Euractiv.

[Edited by Vasiliki Angouridi, Brian Maguire]