Slovak Hospital Group Warns State Debt Relief Deepens Inequality

Slovakia's Ministry of Health presented a 1.6 billion euro debt relief proposal for state hospitals to the sectoral council on October 6, prompting the Asociácia nemocníc Slovenska (ANS), the country's hospital association, to warn that further debt relief will deepen long-standing inequalities in how the state treats hospitals depending on their founder.¹

Unequal treatment alleged

According to ANS president Marián Petko, state hospitals already benefit from advantages unavailable to non-state institutions, including exemption from social insurance contributions and state reimbursement for installing air conditioning. Petko said state hospitals would again be favoured under the new plan, while regional hospitals face criticism for being better financed. "Štátne nemocnice budú opäť zvýhodnené a našim regionálnym nemocniciam kritici vyčítajú, že sú financované lepšie," he said.¹

Petko pointed to a 2024 memorandum between the Lekárske odborové združenie (LOZ) medical trade union and the health ministry, in which the state committed to preventing further hospital debt through changes to the program decree. He said this commitment has not stopped debt from growing. "Paradoxne práve v rámci neho sa štát zaviazal, že úpravou programovej vyhlášky nedôjde k ďalšej tvorbe dlhu nemocníc," Petko said. The ministry stated that if agreement is reached with the finance ministry, debt relief would take place in the first half of 2027, and said the relief would apply to all institutional healthcare facilities under equal conditions regardless of founder type.¹

Scale of hospital debt

State hospitals are chronically indebted, with debt exceeding 1 billion euros, according to ANS. The association attributes much of this to LOZ memoranda that raised doctor wages without attaching performance conditions, resulting in state hospitals spending up to 90 percent of insurance revenues on employee wages. ANS first vice-president Igor Pramuk said efficiency improvements could generate savings in the hundreds of millions of euros, and that further state debt relief will not work without systemic reform.²

Pramuk said wages have risen while productivity has fallen in state hospitals, and that a large share of healthcare services has shifted to day-care and outpatient facilities. He argued that state hospitals should remain critical infrastructure without privatisation, but that the system cannot reward inefficiency. he said he firmly believed hospitals owned by the state must continue functioning as essential government infrastructure that cannot be sold into private hands. Zároveň však systém nemôže odmeňovať neefektivitu," he said, citing the Východoslovenský onkologický ústav, Nemocnica v Poprade, Nemocnica sv. Michala and cardiac centres as examples of functioning state-owned facilities.²

Disputed figures

ANS disputed claims made by an official named Visolajský about hospital financing, calling them false and misleading and saying they rely on outdated 2023 data that does not reflect 2024 payment changes. According to ANS, the 2024 payment decree favoured state hospitals over smaller ones, allocating 191 million euros to state hospitals at the expense of smaller institutions. Petko said this allocation came "na úkor menších nemocníc," or at the expense of smaller hospitals.²

ANS said its 82 member hospitals received a combined 820 million euros from health insurers, while 24 state hospitals received 1.4 billion euros from insurers plus hundreds of millions of euros in debt relief and other funding, totalling nearly 2 billion euros. The association said state hospitals have access to multiple funding sources beyond insurance payments, and that shifting funds toward large hospitals threatens the wages of healthcare workers in regional hospitals. Petko said discussion on financing should be based on facts and should aim to improve the availability and quality of healthcare.²