EAPC Country of the month - Slovakia

Health care

The health care system in Slovakia is based on universal coverage, compulsory health insurance, a basic benefit package and a competitive insurance model with selective contracting and flexible pricing. Health care, with exceptions, is provided to insured for free through benefits-in-kind. At the end of 2013, there were registered 13,022 healthcare establishments in the operation of 11,904 healthcare providers. The outpatient healthcare establishments accounted for 78 %, institutional healthcare establishments for 1.4%. The healthcare in these establishments was provided by 24,049.08 work positions of independent healthcare professionals.

Total health spending accounted for 8.1% of gross domestic product (GDP) in the Slovak Republic in 2012, lower than the average of 9.3% in OECD countries.

Risk factors

The average life span in Slovakia is 72.5 years for men (about five years lower than the EU) and 79,9 years for women (about 3,20 years lower compared to the EU average). The sex-based difference in the average life span has changed over the last 10 years about 2,5 vs. 2,2 years. The age-standardised death rate (SDR) for cardiovascular diseases has decreased since 2004 by 26%. Nevertheless, it is still 50% higher compared to the average SDR in the EU (58% higher in men and 43% higher in women).

Table 1: The prevalence of the main CV risk factors in Slovakia (2012)

Main actors & prevention methods

The main authorities acting in the prevention area are:

• Ministry of Health: Formulates and evaluates policies for health and the strategic planning of health services.
• Public Health Authority of the Slovak Republic plays a fundamental role as the central government’s expert and supervisory institution.
• Chief hygienist (principal hygienist, medical doctor and Head of Public Health Authority of Slovakia): The main tasks, among others, includes prevention of main risk factors including smoking, overweight and poor physical activity.

Prevention activities

• Network of Regional Authorities of Public Health (RAPH) - Counselling  Health Centres provide individual and group interventional activities (smoking cessation,, healthy nutrition, increasing physical activity, hypertension,…).
• World Heart Day:  the Slovak Heart Foundation in cooperation with the Slovak Society of cardiology, RAPH and other non-profit organisations organize every year nationwide campaigns called “MOST” (Mesiac O Srdcových Témach (the Month On the health Topics) in more than 40 cities every year.
• The activities include walks, health checks and education.
• World NO Tobacco Day & World Hypertension Day: Both events are organised in Slovakia every year.
• Campaign: Stop smoke, eat apple.
• Challenge your heart to move: national campaign with aim to increase physical activity is organising every two years. A number of events and campaigns promoting physical activity are organised each year on the regional level.
• Fruits at school:  Campaign promotes healthy food at schools. In most schools pupils are given "second breakfast" consisting of fruits, vegetables and milk or fruit juice several times a week. The goal of this initiative is to change eating habits of children. The campaign is supported by Ministry of Education and Ministry of  Agriculture.
• Project: „I am 65+, I live healthy“ is delivered for seniors.
• Educational activities of the Slovak Society of Cardiology.

Cardiac Rehabilitation

First stage of rehabilitation starts from the rule in the cardiology or heart surgery departments. The second stage is usually provided by specialised rehabilitation centres. Some of them are hospital-based, but most patients participate in three to four weeks rehabilitation programmes consisting of group-based therapies (exercise training, relaxation and stress management training, education therapy and lifestyle change therapy) usually in specialised cardiac rehabilitation centres. There are seven active cardiac rehabilitation centres nowadays in Slovakia.

Approximately 60% of all patients undergoing heart surgery or suffering from an acute coronary syndrome participate in a second stage of rehabilitation programme (up till three months post-event). In contrast, 74% of the patients, mostly those after revascularisation on peripheral arteries, participate in the third stage of rehabilitation. 

Aims for the future

• The primary care system needs strengthening so that much more patients are treated in general and in prevention management instead of being referred to a specialist.
• Plans include focusing on CV health promotion with continuous nationwide education on CVD prevention including smoking cessation, increase of physical activity and obesity prevention.
• Increasing activities for early detection and treatment of high risk asymptomatic population.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.