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15 August 2025 | Country Update
Slovakia’s €2 billion ambulance tender sparks political and legal turmoil -
15 July 2025 | Policy Analysis
Steps to reform emergency medical services in Slovakia -
16 April 2018 | Policy Analysis
Overhauling the network of emergency services and new provider selection
5.5. Emergency care
Emergency care provides urgent care in sudden life-threatening situations or care during childbirth. Two different emergency call centres, operated 24/7, are the primary method of accessing emergency care.
- Domestic patients dial the 155 hotline which is staffed by non-physician health care personnel who have undergone emergency care training.
- The international 112 line is serviced by universal operators, who offer consultancy in Slovak and English.
Emergency calls are received at the state-run National Emergency Centre, which dispatches ambulances. The National Emergency Centre is fully financed by the Ministry of Health and has eight regional centres. A special training programme for emergency phone operators was accredited in 2014. A physician who specializes in urgent medicine or anaesthesiology and intensive care is also on call for consultation 24/7 on the emergency hotline.
In 2004 a reform of emergency medical services led to the design of a nationwide network of 273 stations to ensure the availability of urgent health care within 15 minutes after receiving an emergency call for 95% of Slovak territory. Emergency departments, dispatching ambulance services, are provided by both public and private entities and are subject to a procurement process administered by the Ministry of Health. They work 24/7 either with a physician-led team (with three members, ERS) or by a two-member team of non-physicians (MRS). Licences for the provision of emergency medical services are issued for a period of six years based on a public tender announced by the Ministry of Health. The last round of procurement occurred in 2013–2014 and has since increased the required number of stand-by ambulance services. Licensed providers are awarded with SHI contracts and monthly payments of €28 426 for the three-member ambulances or €16 343 for the two-member ambulances, €30 749 for stand-by of mobile intensive care units, and additional fees per kilometre.
In 2016, 92 out of the 274 emergency departments consist of a three-member and physician-led team. Seven emergency medical service helicopters exist. These services are operated by 14 companies, of which eight are private entities and six are regional or municipality-run hospitals (AZZS, 2015). The law requires ambulances to be dispatched within two minutes of dispatch notice. See Fig5.6 for an overview.
Fig 5.6
In 2013 the total number of emergencies was slightly above 500 000 and the average response time was 11.3 minutes. However, only 75% of cases were reached by an ambulance within 15 minutes (see Table5.2).
Table5.2
The minimum requirements for material, technical and human resources of ambulances and emergency centres are determined by law. Inpatient health care facilities within the contracted network establish the emergency care framework. They are required by law to provide emergency care at least in the following departments: (a) urgent admission department, (b) anaesthesiology and intensive care, (c) surgery, (d) internal medicine or cardiology, (e) neurology, (f) gynaecology and obstetrics, (g) neonatology, (h) paediatric medicine and (i) a hospital pharmacy. The providers in the network must ensure 24-hour accessibility of the above-mentioned specialized departments, common diagnostic and treatment facilities in radiodiagnostics (a CT scan is essential), clinical biochemistry, haematology and transfusion treatment. Secondary transports, e.g. between hospitals because adequate treatment cannot be guaranteed, play an increasing role in Slovakia, although EC regulations require transport only to hospitals with adequate diagnostics and necessary follow-up treatment care.
In 2006 user fees for ambulatory health care were abolished with the exception of a medical first aid service fee of €1.99 regardless of where care is given.
Slovakia is facing a major public procurement controversy involving the tendering of its emergency medical services. The EUR 2 billion contract, covering both ground and air ambulance operations from 2025 to 2031, has become the largest healthcare tender of the current government – and is now mired in allegations of cronyism, lack of transparency and possible breaches of procurement law. Political tensions, media scrutiny and prosecutorial involvement have converged to make this one Slovakia’s most significant governance crises of 2025.
Tender overview
The Operational Centre of the Emergency Medical Service, on behalf of the Ministry of Health, launched the tender to allocate licences for 344 ground ambulance stations and 7 air ambulance bases nationwide in May 2025. The aim was to ensure the provision of high-quality, continuous emergency services across Slovakia. The winning bidders would secure operational rights for a six-year period, with the contract value estimated at EUR 2 billion (The Slovak Spectator, 2025a).
Transparency concerns
Criticism quickly emerged from opposition parties, the Slovak Medical Chamber and transparency watchdogs. They highlighted opaque selection procedures, including a refusal to disclose the names and qualifications of tender committee members.
In July 2025, preliminary results of the tender and the names of the commission members were leaked to the media, which confirmed concerns about poor transparency and fairness of the tender (The Slovak Spectator, 2025a).
One particularly contentious claim is that the tender process might be structured to favour certain bidders, notably Agel SK, Slovakia’s second-largest private healthcare provider, and a relatively unknown entrant, Emergency Medical Solutions (EMS). Both have reportedly been in positions to gain a disproportionately large share of contracts (The Slovak Spectator, 2025b). EMS was later proven to be linked to the second largest coalition party, HLAS-sociálna demokracia, which also nominated (as of this writing) incumbent Minister of Health, Kamil Šaško.
As a consequence, on 8 August 2025, Penta Hospitals, Slovakia’s largest private healthcare network, withdrew its bid, citing serious concerns over transparency and suggesting possible breaches of EU procurement law (The Slovak Spectator, 2025b).
The Slovak National Party (SNS), another governing coalition partner, demanded not only the cancellation of the tender but also the resignation of Health Minister Šaško. Prime Minister Robert Fico publicly acknowledged that the process could be scrapped or restarted if doubts persisted (TASR, 2025).
The General Prosecutor’s Office, led by Maroš Žilinka, initiated a preliminary review into the tender process. This action signals potential criminal investigations for alleged mismanagement of public funds and violations of procurement rules (The Slovak Spectator, 2025b).
Nevertheless, the management of the Operational Centre of the Emergency Medical Service delivered the results of the tender to the Ministry of Health on 11 August, thereby de facto announcing the successful selection procedure. On the same day, Minister of Health Šaško, announced that he would not sign it and would cancel the tender procedure, and would come up with an alternative for procuring emergency services in Slovakia, pending agreement within the governing coalition. Conclusions of such discussions are expected by the end of August 2025.
The opposition and experts claim that Health Minister Šaško could not terminate the tender and did so in violation of the law, which may cause the bidders to suffer lost profits, and are therefore demanding his resignation (TASR, 2025b).
References
The Slovak Spectator (2025a) News digest: Unqualified officials, secret committees. Ambulance tender raises red flags. SME.sk. Available at: https://spectator.sme.sk/politics-and-society/c/news-digest-unqualified-officials-secret-committees-ambulance-tender-raises-red-flags (Accessed: 15 August 2025).
The Slovak Spectator (2025b) News digest: Ambulance tender turmoil – Penta walks, prosecutor limbers up. SME.sk. Available at: https://spectator.sme.sk/politics-and-society/c/news-digest-ambulance-tender-turmoil-penta-walks-prosecutor-limbers-up (Accessed: 15 August 2025).
TASR (2025) Ambulance tender scandal: Political pressure mounts, PM and SNS weigh in. TASR. Available at: https://www.tasr.sk/tasr-clanok/TASR%3A2025080700000344 (Accessed: 15 August 2025).
TASR (2025b) According to Šaško, the tender for ambulances was cancelled in accordance with the law. “Anyone who questions this is lying”, he said. PRAVDA. Available at: https://spravy.pravda.sk/domace/clanok/763156-sasko-tender-na-zachranky-bol-zruseny-zakonnym-sposobom Accessed: 15 August 2025).
General overview
In March 2025, the Slovak Government approved the most significant reforms to the emergency medical services (EMS) system in over two decades. Although the initial implementation date was set for 1 January 2025, the new legislation will be introduced in phases, and commenced on 15 April 2025. It includes structural changes to ambulance services, the development of a new ambulance network and the introduction of a new professional role.
Structural changes to ambulance services
Several new types of ambulance crews will be deployed. One of the most notable is the hybrid rapid medical assistance (RLP)/rapid medical aid (RZP) model, whereby a physician-staffed RLP unit will operate during daytime hours, and an RZP crew without a physician at night. This measure is designed to optimize the use of physicians, whose availability in the Slovak health system is limited.
Another innovation is the RZP crew with extended-scope specialist paramedics. These paramedics will be authorized to perform advanced medical interventions previously reserved for physicians, with the intention of accelerating care delivery, particularly in remote or underserved areas.
The reform also introduces specialized ambulance types, including:
- Planned transport ambulances for non-emergency inter-hospital transfers and selected low-acuity primary calls, freeing doctors and paramedics for acute cases.
- Mobile paediatric intensive care unit ambulances, operated by tertiary paediatric healthcare facilities, to ensure critically ill children are transported by personnel trained in paediatric emergency medicine.
- Emergency medical assistance ambulances for repatriation (if a patient is abroad and needs transport back to Slovakia) and other non-insurance-covered transport needs, such as medical coverage at social, cultural and sporting events.
Development of a new ambulance network
The EMS network will be redesigned based on a mathematical optimization model that uses historical data on response times, call volumes, call types and geographic distribution of incidents. This model will propose optimal crew deployment to minimise response times and maximize coverage.
As a result, the number of ground ambulance service stations in Slovakia will increase from 321 to 344 from the next tendering period, beginning in Autumn 2025. Additionally, the reform specifies more precise regulations for the location of EMS stations in regional capitals to improve equitable access across urban areas and surrounding municipalities.
A commission within the Ministry of Health will monitor compliance with newly established quality indicators for both EMS providers and emergency dispatch centres. The first set of indicators was published in the Official Gazette in mid-2025, with systematic measurement scheduled to commence in 2026.
Introduction of a New Healthcare Professional Role
The legislation also creates a new category of healthcare worker: the transport assistant. Transport assistants, similar in status to nurses within the EMS system, will be formally registered with the Slovak Chamber of Emergency Medical Technicians. This ensures both professional representation and access to continuous professional development opportunities.
Another key feature of the reform is the planned introduction of a new emergency telephone number, 116117, in January 2026. This number will handle non-urgent medical inquiries, thereby alleviating the workload on the existing emergency number 155, which will continue to be reserved for urgent, life-threatening cases. The aim is to enable EMS teams to concentrate their resources on critical incidents requiring immediate intervention.
References
Fekete, B. (2025) Vláda schválila najväčšiu reformu záchraniek za posledné roky. Čo nás čaká? (The government has approved the biggest reform of the emergency services in recent years. What can we expect?). MEDICINA Trend. Available online from: https://medicina.trend.sk/2025/03/12/vlada-schvalila-najvacsiu-reformu-zachraniek-za-posledne-roky-co-nas-caka
Jeseňák, Š., Gaston, I. and Majerský, F. (2025) František Majerský & Gaston Ivanov: Najväčšia reforma záchrannej zdravotnej služby za 20 rokov s cenovkou 1,2 miliardy € (František Majerský & Gaston Ivanov: The biggest reform of the emergency medical services in 20 years, with a price tag of €1.2 billion). Ozdravme.sk Available online from: https://www.ozdravme.sk/Dokument/101831/frantisek-majersky-gaston-ivanov-najvacsia-reforma-zachrannej-zdravotnej-sluzby-za-20-rokov.aspx
Emergency services have been targeted by a major reform of technical parameters, provisional requirements and redefining its functions in 2017. The operation of medical first aid stations have been seen as financially unattractive for a long-time, and suffered from a shortage of medical doctors.
In 2017, a comprehensive MoH analysis identified 76 regional "points" in emergency service coverage for adults and 61 for children (assuming to cover 99% of Slovakia within 15 minutes). These potential stations were added to providers network and given a minimal payment from HICs of roughly 99 500 EUR per year to cover all its personnel and key operating expenses. Interested providers are to compete in a public tender. If a EMS stations exceeds this yearly budget, any additional treatment is reimbursed in a standardized procedure, i.e. payment per treatment. Similarly, if a provider decides to open a LSPP outside the identified spots, there is no such fixed payment.
Key operating principles of EMS stations were also changed. The opening hours were reduced from overnight operation and currently span from only from 16.00 to 22.00 during workdays and 7:00 – 22:00 during weekends. If a provider offers longer consulting hours, there will be no fixed payment is provided for these additional services. Furthermore, the minimum salary of a doctor in LSPP was set at 12 EUR gross per hour.
In a second step, in-patient emergency care delivery was also reformed to guarantee a smooth transition of patients. After a detailed analysis of current operations, demand for care, movement of patient, social factors and accessibility criteria at a regional and national level, the provision of in-patient provision of emergency care is reorganised into two levels.
- Emergency department Level 1 (provided by 32 hospitals) are responsible for basic emergency services during 24/7 opening hours. Additionally, Level 1 hospitals are obligated to provide at least one FTE of a doctor and a nurse. Emergency departments level 1 will receive a monthly fixed payment of 26 700 EUR.
- Level 2 inpatient emergency services are to be provided by 6 hospitals and 3 paediatric hospitals. Hospitals of this level have a catchment area of roughly one million inhabitants and will provide all services needed, including diagnostics and intensive care, without a need to transport patients to another hospital to receive acute treatment. Staffing requirements are stricter, with at least 4 FTE of doctors and 8 FTEs of nurses. All providers on level 2 receive a monthly payment of 97 300 EUR, excluding payment for treatment and additional services.
The first round of bidding process for the selection of operators for these points ended in May 2018, but did not prove to be a success, having selected roughly 40% of points. The second round of the selection process started in june 2018.
Authors
References
Janečková (2017) Zmeny na pohotovostiach. Pozrite sa, ako sa dotknú vášho okresu. [Changes in emergency services - how will it impact your district] [Online]. Available at: https://spravy.pravda.sk/domace/clanok/436278-poplatky-za-navstevu-pohotovosti-by-mali-vzrast-z-1-9i-eura-na-10-eur/ (Accessed on 6th of June, 2018)