Slovak Ombudsman Asked to Review Outpatient Healthcare Regulations

Two associations representing Slovak outpatient doctors, Zväz ambulantných poskytovateľov and Asociácia súkromných lekárov SR, filed a petition in Bratislava in September asking public ombudsman Róbert Dobrovodský to review regulations governing the country's ambulatory healthcare sector.¹

The petition

The petition asks the ombudsman to examine how public resources are distributed between hospital and ambulatory care, how personnel capacity and generational renewal in outpatient medicine are managed, and how demand for healthcare is regulated. It also requests that the ombudsman seek formal positions from the government, the Ministry of Health and the Ministry of Finance.¹

Jaroslava Hanali, head of the union's office, told TASR that the submission does not target any single insurer decision or payment mechanism. She said the complaint is not directed at any single insurer's decision or a specific payment arrangement. Rather, she said, it draws attention to how outpatient funding, workforce levels, generational turnover among doctors, and patients' real-world chances of getting needed treatment are all connected.¹

Round table and financing figures

In September a round table on the state of ambulatory healthcare brought together representatives of ASL SR, ZAP, the Asociácia na ochranu práv pacientov, the ombudsman and state secretary Michal Štofko from the Ministry of Health, along with analyst Martin Smatana. Participants agreed that the ambulatory sector needs systemic solutions and stable operating conditions, and discussion covered a high volume of doctor visits, a shortage of ambulatory doctors and an unfavourable age structure among them.¹

Data presented at the meeting indicated that the ambulatory sector in Slovakia accounts for 35.3% of healthcare funding, compared with an EU average of 46.3%, according to the association. ASL SR president Marián Šóth said the sector is at the limit of its capacity and cautioned that neither access problems nor the question of fees could be solved unless ambulatory care is strengthened. Ultimately, he said, patients in Slovakia would bear the consequences.¹

ASL SR also presented a proposal for a traffic-light system to prioritise patients by medical need. Representatives of ambulatory care said they are not seeking preferential treatment but want healthcare treated as a single system, adding that they do not question the need to stabilize hospitals either. Rather, they want the state to approach healthcare as a unified system and to put in place clear, predictable and lasting conditions for outpatient services too. They added that abolishing fees or repressive measures would not improve the situation, and that economic sustainability requires clearly defined patient entitlements.¹

Ombudsman's earlier proposal and reaction

Before the round table, Dobrovodský in August had proposed shifting responsibility for ensuring healthcare accessibility from patients onto health insurance companies, saying, "Pacient nemá byť ten, ktorý chodí so zoznamom v rukách po celom Slovensku a hľadá lekára." He argued that although insurers are legally obliged to secure accessible care for policyholders, in practice patients receive a paper referral and must call around themselves: "Ale zdravotná poisťovňa v praxi vybaví tú zodpovednosť tak, že pacient končí s papierom v rukách a začína obvolávať."³

Healthcare analyst Jana Ježíková noted that the legal obligation already exists, stating, "Odjakživa je v zákone veta, že zdravotná poisťovňa je povinná zabezpečiť poistencom dostupnú zdravotnú starostlivosť." According to Noviny.sk/TV JOJ, patients often find specialist care only after unacceptably long waits or excessive co-payments, and the electronic referral system does not function as intended; some patients also try to see specialists without first consulting a general practitioner.³

ZAP president Jaroslava Orosová warned that forcing insurers to locate specialists for patients would quickly collapse given the scarcity and chronic underfunding of specialized outpatient practices. Všeobecná zdravotná poisťovňa spokesperson Danka Capáková said insurers already help patients find doctors and cautioned that legislative change alone, without comprehensive systemic measures, would be unenforceable, noting that the insurer would follow any new law just as it always has. She added that without a full package of systemic measures being adopted and put into practice, the proposed change could not actually be carried out. Health Minister Kamil Šaško said work on solutions including mandatory registration and fee policy was already under way, pointing out that compulsory registration had already been introduced. Zároveň je veľká téma poplatkov, však? Už pracujeme na riešení."³

Ombudsman's priorities

SME reported that Dobrovodský came into the September sector talks with a set agenda: making fee rules more transparent, resolving legal ambiguities that affect patients, ensuring laws are interpreted consistently, tightening oversight, and establishing a patient's legal entitlement to an assigned outpatient doctor.²