On 20 March 2024, the Ministry of Health published Decree No. 55/2024, which defines the amounts of expenditure for each type of health care in the budget for each of the three health insurance companies (HICs) for 2024 (the so-called Programme Decree).
Health insurance expenditures are expected to be 11.5% higher than in 2023, amounting to EUR 7.68 billion in 2024. The primary drivers of the increase in expenditures are hospitals (19.3% annual increase), medical devices (18.5%) and outpatient specialized services (11.4%), as captured in Table 1.
Table 1
The budget, despite the fact that there is a fixed payment for the state’s policyholders from 2024 onwards, is calculated as in previous years, that is, the sum of expenditure for existing policies, for policy changes and subtracting the planned austerity measures, as shown in Figure 1.
Figure 1
Impact of existing policy measures’ growth on 2024 expenditure
Without taking any new measures, the expenditure on health services will grow by roughly EUR 521 million. The largest increase is due to wage growth in the sector, followed by medicines and medical devices, inflation and ageing.
Each year, the budget assumes that health workers’ wages will grow at the same rate as the average wage in the economy. The total of these automatic wage increases for all hospital and ambulance staff is set at EUR 253 million for 2024, representing a 7.7% annual increase in the basic component of the wage and the components linked to it.
Due to the categorization of new medicines and medical devices that already took place in 2023, a natural increase is also budgeted for this item, with an expected increase on medicines and medical devices by a total of EUR 124 million.
The budget also covers the natural increase due to inflation and ageing. Expected CPI inflation, which was forecast by the Finance Ministry when the budget was drawn up, is projected at 4.9% for 2024. The natural growth in health care output, and hence in ageing expenditure, is budgeted at EUR 43 million.
Impact of policy changes on 2024 expenditure
EUR 283 million is earmarked in the decree for measures and priorities of the ministry that go beyond natural growth, as explained in the previous section. The largest policy change is the additional financing of institutional health facilities to the amount of EUR 261 million above the growth in personnel costs and inflation, prioritized for the following purposes:
the top-up funding of hospitals under the competence of the Ministry of Health for an amount of EUR 191 million, and
to cover the increase in production due to the reduction of waiting times, the introduction of DRGs and the implementation of the optimization of the hospital network, with a budget of EUR 70 million.
The top-up is aimed at activities that are not sufficiently taken into account and covered under today’s payment mechanism. Without the increase, further indebtedness of hospitals would be imminent for 2024. Slovakia is already facing a lawsuit from the European Commission before the European Court of Justice for late payments by state hospitals. The Commission is calling on Slovakia to address the problem systemically and this increase should be a basic and first of many initiatives to improve financial state of state-owned hospitals.
Depending on the success of the implementation of the austerity measures (see below), additional resources may also be brought into outpatient healthcare. The full savings potential amounts to EUR 100 million; the realized savings will be redirected to the outpatient sector, the final amount of which may be lower and will depend on the success of the implementation of the measures
Austerity measures planned for 2024
The potential for austerity measures (stemming from the 2022 spending review) is estimated at EUR 84 million. Successful implementation of austerity measures is a prerequisite for the implementation of the new catalogue of procedures in the outpatient sector. A list of these measures is shown in Table 2.
Table 2
