In the wake of Slovakia’s splintered election result in spring, and the formation of a messy four-party governing coalition, Tomas Drucker looked an inspired choice for health minister. Fresh from being named manager of the year by the business weekly Trend in 2015, the political novice was tasked with reforming a sector deemed an “octopus” by the Slovak press for the myriad corrupt tentacles running throughout the system.
Nominated by Prime Minister Robert Fico’s Smer party, Drucker largely got the job because none of the coalition parties wanted responsibility for untangling the mess. A study by Sweden’s Health Consumer Powerhouse found that the poor state of the health system shaves 12 years off the average Slovak lifespan. According to the OECD, the state spent just 7.6% of GDP on health in 2013, compared with an OECD average of 8.9%. Even Fico – who has since undergone double bypass surgery – admitted on a television talk show earlier this year that he avoids the country’s hospitals “like the plague”.
In an interview with bne IntelliNews, Drucker concedes he has a formidable task ahead of him and that Slovakia’s healthcare problems, like elsewhere in Central and Eastern Europe, have been “accumulating for years”.
Though largely sceptical of any Smer nominee, reformists had reason for optimism within days of Drucker taking office in late March. He promptly fired the head of the Health Care Surveillance Authority (ÚDZS), Monika Pažinková. Not only has she been blamed for turning a blind eye to shady procurement deals in recent years, but a series of unexplained donations from Smer party loyalists had also turned her husband’s near-bankrupt polyclinics in the eastern city of Prešov into financial success stories overnight.
Drucker tells bne that such personnel changes were necessary to clear out officials lacking in “moral character” and that future hires would be based – in what would be a radical break from the past – “expertise”. In another bold early move, procurements at public hospitals must now be cleared by the health ministry itself, with specifications for new equipment and research on the products on the market sent and cleared before the bidding process even begins. Drucker also cancelled a host of contracts that were signed by the previous Smer government in the final weeks of their term.
“With most ministers we know what to expect, but he can surprise us both in a positive and negative way,” opposition MP Miroslav Beblavy says of Drucker.
Reluctant to place blame on individuals for the system’s many ills, Drucker answers questions like a manager, not a politician. He outlines a catalogue of priorities, including “reducing waiting times for planned operations”, creating “multi-source financing”, a better system for cheaper “outpatient care”, “increased transparency at all levels of the system”, and a shift toward electronic record keeping. But such goals are hardly unique to Slovakia.
Many of the problems such policies are meant to address are symptoms of a larger ill common across healthcare systems in the post-communist world, which is that spending outpaces revenue. “Hospital costs are not adequately covered by the revenues from the health insurance companies,” explains Drucker simply.
In Slovakia, hospitals carry some €500mn in debt. Small and medium-sized hospitals say they will fall €95mn short of breaking even this year, according to the Association of Hospitals of Slovakia. Meanwhile, the Association for the Protection of Patients’ Rights expects a €220mn shortfall in the healthcare system as a whole in 2016.
Some of this can be attributed to waste, including a series of major procurement scandals in the Slovak system in recent years, but there are few who would dispute that a wider overhaul is needed. In the neighbouring Czech Republic, earlier right-leaning governments sought to combat deficits by instituting CZK30 per visit over-the-counter fees for each doctor visit (which were rolled back by the current Social Democrat-led government).
A lack of funds creates other problems in healthcare systems throughout the region. In Poland, cash-strapped doctors feel pushed into collecting additional fees off the books and nine out of 10 of all bribes are in the healthcare sector. About a third of Romanian doctors left the country between 2011-13 in search of better wages and working conditions. Drucker concedes that debt in the Slovak health sector represents a “a risk for public finances”. He plans to approach such problems with “zero tolerance for wasteful spending”, but also says the state will have to devise a plan for “debt relief”.
The metaphorical Slovak healthcare octopus is frequently entangled with the politically influential financial group Penta, as well as Fico’s ruling Smer party. While the former earns €160mn in revenues with its 14 hospitals in the Svet Zdravia chain last year, the latter has toyed with the idea of returning to a single-payer healthcare system. With no money to finance the transition and Fico’s power now on the wane, that plan now looks to be dead, yet Drucker nonetheless dodges a question on whether he would ever back such a plan. “In handling public resources, it is most important to set up the best system of control so that it is clear how the resources of insured persons are used,” he says.
Such answers cement Drucker’s reputation as someone trying to stay above the political fray and he indeed got the job on the back of his reputation for turning around Slovak Post. In 2012, he managed to cut losses at the state postal service from a forecasted €9mn to less than €3mn. In 2015, Slovak Post ran a surplus, with increased revenues coming as it broadened services to offer more banking and insurance products, as well as mobile phone service. “Some management practices that we have applied to the Slovak post office will be feasible even in the health system,” Drucker says, although the work will almost certainly be “more sensitive”.