The debate over inefficient state hospitals misses a deeper problem: a system in which insurers and providers profit from both sides of the transaction.
Renáta Bláhová is a partner at BMB Partners TAXAND, a member of the Advisory Board of the Slovak-German Chamber of Commerce, and the former head of the Health Care Surveillance Authority (ÚDZS).
The economic results of the audit in selected state hospitals were presented and discussed in recent weeks as shocking. The alleged surplus of doctors, low utilisation of operating theatres, and unsustainable wage costs triggered strong reactions from experts and politicians alike, while avoiding one of the key issues. The interview with Penta Hospitals chief Peter Lednický last week, in which he commented on the construction of Bory Hospital and criticised state hospitals, also avoided a key issue of the Slovak healthcare system.
Penta today operates in the Slovak healthcare sector through a cross-ownership structure that creates a permanent conflict of interest: through its health insurer Dôvera, it controls a substantial share of public health insurance funds, while through its hospitals and other healthcare facilities, it also profits from how those same public resources are spent (see chart below). The volume of funds in the health care sector in Slovakia is growing at a record pace, reaching €10 billion this year. In such a setup, the debate cannot end with whether state hospitals are managed efficiently enough; it must also ask who controls the flow of money, who sets the incentives, and who is supposed to oversee a group that, in practice, stands on both sides of the transaction.
