As explained in a previous policy analysis (https://eurohealthobservatory.who.int/monitors/health-systems-monitor/analyses/hspm/slovakia-2016/slovakia-s-health-care-surveillance-authority-s-lacking-institutional-stability-and-independence), the Health Care Surveillance Authority (Úrad pre dohľad nad zdravotnou starostlivosťou in Slovak) plays an important regulatory role in the Slovak health system and is responsible for supervising health insurance, purchasing and healthcare markets. As with previous governments (no chair of the Health Care Surveillance Authority has served a full term since its establishment in 2004), the current government led by Prime Minister Robert Fico with Minister of Heath Zuzana Dolinková have politicized the role of the Authority’s chair. In February 2024, they used legislative amendments to §22 of Act 581/2004 to remove the then-incumbent Renáta Blahová.1, 2
More recently, the Fico government has adopted legislation to take effect on 1 August 2024 to change the criteria of who can serve as director of the National Institute for Value and Technologies in Healthcare (NIHO or Národný inštitút pre hodnotu a technológie v zdravotníctve), which was established in 2022 and is responsible for Health Technology Assessment in Slovakia. The new criteria specify that only a doctor or pharmacist could serve as head of the HTA agency (leading to the dismissal of the current head, Michal Staňák); the legislation also enables the Minister of Heath to dismiss the agency’s director at any time and without cause.
Besides the political sphere pushing itself into the decision-making levels of these two seemingly independent organizations within the health system, the current government has also used their existing authority to make the following changes in healthcare institutions and providers around the country since coming into office in October 2023 (the dates refer to when the officials were dismissed or replaced):
- Tomáš Janík, director of Faculty Hospital Trenčín, 14 November 2023.3
- Vladislav Šrojta, director of Faculty Hospital Trnava, 30 November 2023.4
- Pavol Bartošík, general director of Central Slovak Institute of Heart and Vascular Diseases (Stredoslovenský ústav srdcových a cievnych chorôb), 5 December 2023.5
- Ľubomír Šarník, director of Faculty Hospital Prešov, 6 December 2023.6
- Jozef Tekáč, director of Faculty Hospital Poprad, December 2023.7
- Eduard Dorčík, director of the hospital in Žilina, December 2023.8
- Peter Potůček, director of State Institute for Drug Control (Štátny ústav pre kontrolu liečiv), 31 December 2023.9
- Ľubica Hlinková, general director of VšZP (Všeobecná zdravotná poisťovňa), the state-owned Health Insurance Company, 10 January 2024.10
- Peter Lukáč, director of National Centre for Health Information (Národné centrum zdravotníckych informácií), 10 January 2024.11
- Ivan Kocan, director of University Hospital Martin, 10 January 2024.12
- Július Pavčo, director of Emergency Medical Service Operations Centre (Operačné stredisko záchrannej zdravotnej služby), 31 January 2024.13
- Renáta Blahová, Chair of Health Care Surveillance Authority, 6 February 2024.14
- Michal Fajin, director of Faculty Hospital Nitra, 14 February 2024.15
- Matej Mišík, chief of the Institute for Healthcare Analyses (Inštitút zdravotných analýz) at the Ministry of Health was revoked on 20.6.2024 without any reason. The Institute focuses on: epidemiological studies and data analysis, sector analysis and health policies, implementation of optimization of the hospital network and the development of the DRG reimbursement mechanism.16
- Michal Staňák, director of NIHO, according to legislation set to take effect on 1 August 2024, enabling the Minister of Health to dismiss the NIHO at any time and without giving a reason. The Ministry of Health has already published the announcement for the selection procedure for the position of the new director.17