1. Spending Review Healthcare
State of play
May 30th 2016

2. Summary – Healthcare According to Ministry of Finance
Over the past 10 years, spending on healthcare in Slovakia has grown significantly, however, healthcare results are poor compared to Hungary, Poland, Czech Republic (amenable mortality, life expectancy)
Funds available in healthcare are perceived as sufficient
We spend a lot on medicines
Hospitals are inefficient (excess capacities and overprices purchases)
Inefficiency in health insurance market
We spend more than other countries on diagnostic imaging, laboratories, transportation and medical rescue services
Data largely unavailable – responsible bodies reluctant to share data

3. Terms of Reference Goal in terms of healthcare results: Fiscal goals:
Lowering amenable mortality to the average level of Hungary, Poland and the Czech Republic by 2020 (1872 less amenable deaths annually)
Fiscal goals:
Spending growth at inflation level
Increase of capital spending of hospitals by 633 mln. EUR over four years (to cover the construction of 3 new hospitals and the renovation of 5 large hospitals)

4. Total spending Total healthcare spending (% GDP)
Total healthcare spending (per capita, PPPs, USD, current prices)

5. (standardized death rate per
Avoidable mortality
High amenable mortality
Deaths that can be prevented by healthcare interventions
Compared with V3, there are 1890 more deaths annually in Slovakia
Amenable mortality
(standardized death rate per
inhabitants)
- bez psychiatrií

6. Difference in life expectancy (women compared with men at birth)
Low life expectancy
(women at birth)
Difference in life expectancy (women compared with men at birth)
- bez psychiatrií

7. So where’s the problem?

8. Capital spending Investment spending in healthcare
(per capita, PPPs, USD, current prices)
Investment spending as a share of total spending (%)

9. Breakdown of spending in 2013
We spend too much on medical goods
We spend too much on ancillary services
We spend more on ambulatory care than the V3 countries
We spend less on inpatient care

10. We’re looking for savings in four major areas
Hospitals
Medicines and other medical goods
Health insurance companies
Diagnostic imaging, laboratories, transportation and medical rescue services

11. Bed occupancy (% of available beds)
Hospital beds
Number of beds
(per 1000 inhabitants)
Bed occupancy (% of available beds)
- bez psychiatrií

12. Hospitals Are hospitals run efficiently?
Benchmarking of hospitals´ operational expenditure (looking for international benchmarks)
Data envelopment analysis of inputs and outputs/ results (useful exercise?), recommendations for greater efficiency
How much could hospitals save if they purchased services at prices achieved by most efficient hospitals/ market prices?
Benchmarking of unit prices of services (data publicly available) and quantification of achievable savings

13. Consumption of medical goods and pharmaceuticals
Consumption of medical goods, including pharmaceuticals (per capita, PPPs, USD, current prices)
Consumption of pharmaceuticals and other medical non-durables
( per capita, PPPs, USD, current prices)
- bez psychiatrií

14. Medicines and other medical goods I
Does health insurance cover drugs that do not fulfill coverage conditions in terms of cost efficiency?
Analysis of cost efficiency of expensive drugs, quantification of savings achievable by fulfilling cost efficiency conditions
Review whether pharmacoeconomic analyses of drugs approved for reimbursement after 2011 meet the statutory requirements
What savings could be achieved if special medical materials (implants, etc.) in each category were only fully reimbursed up to a particular level and co-payments were introduced for more costly alternatives?
Quantification of savings with reimbursement at level of cheapest and median good in each category

15. Medicines and other medical goods II
Can medicine consumption and spending be cut by introducing prescription guidelines?
Analysis of differences in medicine prescription for similar diagnoses
Is our medicine consumption too high?
International comparison of consumption of medicines and medical goods (inpatients drugs, outpatient drugs, etc.) in specific categories
Comparison of declared morbidity and drug consumption

16. Health insurance market
Spending on health administration and health insurance (per capita, PPPs, USD, current prices)

17. Health insurance companies
Does the distribution of health insurance contributions among health insurance companies reflect their costs?
Analysis of redistribution mechanism
Are health insurance companies managed in an efficient manner?
Comparison of operating costs and quantification of achievable savings (looking for international benchmarks)
Does the health insurance market allow the creation of economic rent?
Analysis of health insurance companies profits (looking for international benchmarks)

18. Spending on ancillary services
Spending on laboratories and diagnostic imaging
(per capita, PPPs, USD, current prices)
Spending on transportation and medical rescue services* (per capita, PPPs, USD, current prices)
*The comparatively high spending on transportation and medical rescue services in Slovakia can be explained by high private spending, which amounts to almost half of total spending. In other countries these services are mostly covered by public spending.

19. Diagnostic imaging, laboratories, transportation and medical rescue services
Are we paying more than other countries?
Benchmarking of unit prices in Slovakia and neighboring countries (looking for international benchmarks)
Quantification of achievable savings with prices at level of surrounding countries

20. Further issues considered

21. Inputs Workforce & salaries
Too few nurses, number declining further; underpaid
Stable number of physicians, close to EU average in number and pay
Too many specialists
Too few GPs

22. Outputs Consultations & hospital discharges Prevention
Too many consultations per inhabitant
Number of hospital discharges per inhabitant slightly higher than EU average
Average length of hospital stay below EU average
Prevention
Breast cancer and cervical cancer screening below average

23. Appendix I: Inputs

24. Work force Too few nurses
Stable number of physicians, dentists and pharmacists

25. Nurses The number of nurses has been falling since 2007
The discrepancy between the number of nurses in Slovakia and in other countries has been growing since 2004

26. Physicians and physicians’ age
Number of professionally active physicians excluding dentists (per 1000 inhabitants)

27. General practitioners and specialists
General practitioners and specialists in 2007 (per 1000 inhabitants)
Slovakia has too few general practitioners
Number of specialists is higher than average
Number of surgeons, obstetricians and gynecologists is higher than in other countries

28. Physicians and nurses’ wages
Income of general practitioner – employed (% of average wage)
Income of nurse employed in hospital (% of average wage)

29. (2013, per million inhabitants)
Medical Technology
Medical Technology
(2013, per million inhabitants)
Medical technologies in hospitals (H) and ambulatory care (A) (2013, %)
- bez psychiatrií

30. Appendix II: Outputs

31. Ambulatory healthcare
Number of consultations
(per inhabitant)
Number of consultations is continuously higher than average (with the exception of 2005)
- bez psychiatrií

32. Inpatient care Number of hospital discharges (per 100 000 inhabitants)
Average length of hospital stay (number of days)
- bez psychiatrií

33. Less surgical procedures compared to benchmarks
(2013, per inhabitants)
- bez psychiatrií

34. Prevention – cancer Breast cancer screening
( % of population aged 50-69)
Cervical cancer screening ( % of population aged 50-69)
- bez psychiatrií

35. Appendix III: Data

36. Data Unavailable I. Hospitals Responsible institution
Quarterly and annual data on economic management of healthcare institutions
NCZI
Annual data on the number and structure of healthcare workers and government emploees in healthcare
Quarterly data on salaries, employees and government employees in healthcare
eHealth data
State-defined quality indicators
UDZS
Economic indicators on healthcare purchasing by health insurance companies
DRG data
Waiting times

37. Data Unavailable II.
Diagnostic imaging, laboratories, transportation and medical rescue services
Responsible institution
Economic indicators on healthcare purchasing by health insurance companies
UDZS
eHealth data
NCZI
Medicines
Quarterly data on issued medicines, medical goods and dietary foods
Quarterly data on prescribed and issued medicines, medical goods and dietary foods covered by public health insurance

38. Data Unavailable III. Background data Responsible institution PCG data
UDZS
National registry of healthcare workers
NCZI
National registry of healthcare providers