Slovakia lost to EU Court of Justice in September over continuous late payments by public hospitals to their vendors. An average payment delay was 397 days. Amid growing health financing struggles of the state-owned General Health Insurance Company and budget prioritization disagreements, Health Minister Zuzana Dolinková resigned on October 4.
On September 19, the Court of Justice of the European Union ruled that Slovakia was in breach of its obligation under the EU Directive (2011/7/EU) that protects European businesses against late payments. Public health entities providing healthcare (public hospitals and other types of organizations) have to pay their commercial debts within a maximum of 60 calendar days, reported Filip Áč of Euractiv. A Slovak Supreme Audit Office report uncovered an average payment delay of 397 days, resulting from serious financial struggles faced by the country’s state-owned General Health Insurance Company (VšZP). Arguments by the EU Court of Justice read:
“From data concerning the average period for payment of debts on the part of public hospitals in commercial transactions, it is apparent that in 2015, 2016, 2017 and from 2018 until the point at which the present application was lodged, the Slovak Republic has continuously failed to comply with Article 4(3) and Article 4(4)(b) of the Directive.”
It was reported the country has avoided a large fine, but the Commission may return to court if the member state does not resolve the situation. Zuzana Dolinková, Health minister of Slovakia, commented earlier on this issue:
“This is a long-standing, systematically unresolved issue that has persisted since 2015. The Ministry’s leadership is intensively negotiating with the Ministries of Justice and Finance to address this matter. At the next government meeting, I will submit a document that will provide a comprehensive analysis and include alternative proposals and measures to resolve the situation.”
It is known that the General Health Insurance Company has a predicted year-end loss, predicted at €169 million as of July, but later adjusted to €95 million. The health insurance agency is currently without a director after its former director, Michal Ďuriš, was fired in August 2024. The first measure to improve VšZP’s financial situation was a hasty limitation of certain one-day procedures in outpatient clinics. The health insurance company terminated contracts with some providers and limited the monthly amount it would reimburse others. Parliament Member Dr Tomáš Szalay warned:
“VšZP’s (General Health Insurance Company’s) financial situation is threatened by the need for a recovery plan, and there is a real risk that it will not have the funds to pay healthcare providers’ invoices. Its policyholders face the possibility of having not shorter, but longer waiting times.”
Amid the growing tension over the deficit of funds faced by the single payer of the country, on October 4, 2024, Health minister Dolinková announced her resignation. Among reasons for Minister Dolinková’s resignation was the recent approval of budget cuts by the Parliament of Slovakia, as part of budget consolidation efforts to reduce the budget deficit across different sectors, which would impact healthcare.
The health sector would get a cut of €259 million, which was primarily allocated for healthcare workers’ salaries. Instead of the initial 9.7% t increase in doctors’, nurses’, midwives’, and other health worker salaries, their wages would grow by only 3%. This led to publicly expressed dissatisfaction by the opposition, and by health worker unions such as Medical Trade Union Association and the Slovak Chamber of Nurses and Midwives. Minister Dolinková emphasised that the reduction has violated the agreement between the government and medical unions regarding salary increases and shared the following on the day of her resignation:
“I consider this consolidation of public finances unacceptable and untenable for Slovak healthcare.”
The Supreme Audit Office of Slovakia stated that during 2018–2023, the Ministry of Health experienced nine different ministers, and the organisational structure of the Ministry of Health was significantly altered 36 times.
