If you are expat who is resident in Slovakia and who suffers from a chronic illness, the care that you will be able to access will depend on whether you are reliant on the public or the private healthcare system, or a combination of the two.Slovakia has a national health scheme into which employees pay contributions directly from their salary, and this is compulsory, so if you are working in the country, you should automatically be signed up with the state healthcare system and will have the same rights as native Slovaks.
However, public healthcare in Slovakia is not yet up to the standard of other European nations, and in particular, an emphasis on acute care entails that provision for chronic illnesses is limited. Many expats choose to engage with the private healthcare sector.
How does the Slovakian healthcare system work?
Currently, you will be eligible for state healthcare as an expat if you make contributions into the national insurance system. Your employer will register you either with the main state scheme, (Všeobecná Zdravotná Poisťovňa or VšZP), or with Dôvera or the Dutch-run Union zdravotná poisťovňa, private health insurers working on behalf of the government.
You do not have to sign up with a GP, but if you do not, you will only be entitled to emergency care, so if you have a chronic illness, it is vital that you register with your local surgery once you are settled.
If you have an EHIC card (Európsky preukaz zdravotného poistenia in Slovakian) you can use this, but it is intended for emergencies rather than being a substitute for full health insurance coverage.
The Slovakian healthcare system and chronic illnesses
The Slovakian healthcare system does not rank highly in global listings and evaluations report that healthcare facilities tend to be better equipped for acute care rather than chronic illnesses. This is due to lack of funding and a perceived lack of planning, rather than because chronic illnesses are uncommon in the country. In 2011, for instance, there were 51,903 reported deaths in Slovakia and about half of these were caused by chronic illnesses.
According to the World Health Organization, Slovakia does not currently have an official basis for the development of clinical guidelines relating to chronic conditions. There is a lack of provision of public nursing homes. Care homes for older people or the local versions of nursing homes tend not to have doctors on the staff. It is reported that many GPs do not have enough experience with symptom management at the end of life.
However, the Slovakian health authorities are attempting to address this imbalance. In 2011 three acute care hospitals were closed and several others became almost exclusively chronic (long-term) care facilities. These changes mean that treatment for chronic illnesses has become somewhat more accessible over the last decade and plans are currently in place to convert more acute units into care units for chronic conditions.
Your first port of call will be your GP. Remember to take evidence of any health insurance along with you. However, there is an ongoing shortage of GPs in Slovakia and the WHO says that they have limited formal rights to prescribe medicines and manage chronic patients.
Patients in 80% of GP consultations end up being referred to a specialist. When chronic patients do end up in the hospital system, it is usually for manageable conditions such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, congestive heart failure (CHF) and hypertension, which could be treated at primary care level.
Applying for disability/sickness benefit
Sickness benefit depends on the number of insurance contributions you have made. For the first 10 days, your employer must pay you, but from the 11th day, the state takes over. For the initial three days of this next period, your benefit will equal 25% of the daily assessment basis, then from the fourth day it is 55% of the daily assessment basis. The maximum monthly earnings used to calculate contributions (on an employed or self employed basis) are currently € 4,290.
If you have paid a set number of national insurance contributions (this will depend on your age and therefore on the number of years you have worked) and are severely incapacitated by your condition on a more long-term basis (defined as longer than a year), you may be entitled to disability benefit in the form of a disability pension. This is defined as whether your ability to perform gainful activity is reduced by more than 40% compared with a healthy person. This will need to be assessed by a qualified doctor. If you are eligible for a disability pension, this should not affect your right to work: you can still continue to work even though you are receiving this state benefit.
The monthly pension is the product of the average personal wage point, the length of the coverage period, and the current pension value (in the region of €10.9930).
Private cover for chronic illness
Given the limitations of care for chronic conditions in Slovakia, many expats choose to take out private health insurance. If you do so, you will find a number of private clinics and hospitals in the country that will assist you in treating and managing your chronic condition.
Remember to check if your potential policy covers pre-existing conditions: the definition of this will vary between insurers. Usually the term applies to any conditions which present symptoms or for which you’ve been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits for diagnosis.
You may also want to check out whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You may need to discuss this directly with your insurer.
The cost of your private insurance will depend on your age and on the nature of your illness.
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