Slovakia

A compulsory social health insurance scheme in Slovakia covers nearly the entire population. The Health Care Surveillance Authority serves as an independent monitoring body for the health provision, insurance and purchasing markets. The Ministry of Health functions as the main regulatory body within the health system. It is also the single shareholder of the biggest health insurance company (VšZP), covering just over half of the population. 

Three health insurance companies (one public and two private) operate the compulsory health insurance system in Slovakia, setting up contracts with health providers and negotiating quality, prices and volumes individually. These companies compete to sign people up mostly based on shorter waiting times and additional services. 

The sources of revenue are mainly wage-related contributions paid by employers and employees, along with general tax revenues used to pay contributions for some subsidised categories of the population, such as dependent family members, students and pensioners. Out-of-pocket (OOP) payments in Slovakia correspond mainly to formal co-payments for prescribed outpatient pharmaceuticals and user fees for health services or goods not covered by health insurance companies.  

Overall, the health system remains very hospital-centric, with a limited role for primary care. GPs act as formal gatekeepers of the health system but this role is not well enforced, and patients often see specialists directly without, in practice, bearing any form of penalty. Even though the eight self-governing regions are required to ensure minimum GP-to-population ratios, accessibility of primary care varies and is reported to be problematic in several regions.