"Despite the adoption of partial measures, there is still a lack of a comprehensive financial management regulation, a functional system of using information systems providing data in the widest possible spectrum of public health policy, a better setting of personal accountability, as well as the creation of an organisational unit that would professionally and methodologically assist subordinate organisations," emphasises Mrs Henrieta Crkoňová, the vice-chair of the Slovak audit office. Based on the current findings, the auditors recommend that the Parliamentary Committee on Health oblige the government to demand a comprehensive concept of sustainable financial management of the health sector from the Ministry of Health. "If the real need and subsequent distribution of public resources in the public health system is not clear, the result will be a constantly multiplying shortage of finances," adds the SAO deputy chairwoman.

"The management of university and faculty health facilities is still a major problem. According to the audit's conclusions, these institutions continue to generate losses, incur debts and pay invoices with a significant time lag," says Mrs Crkoňová. At the end of 2023, the liabilities of the 13 largest hospitals amounted to over one billion euros. 

"Another risk confirmed by the audit is that a significant part of the debts of hospitals has fallen into private hands, and their recovery with penalties can significantly burden the health budget and drain the finances, which should be primarily used for the treatment of patients, the operation of hospitals or the salary of doctors and medical staff," stresses the deputy chairwoman of the Slovak auditors. In the last twenty years, the state has proceeded to debt-financing the healthcare system five times; this year it should be the sixth time. By the end of last year, more than 2.2 billion had been spent on debt repayment.

Slovakia has been violating the European directive on combating late payments in commercial transactions, for which it has been facing a European lawsuit since last year. The country faces multi-million dollar sanctions. In April 2024, the health ministry issued a decree that includes a short-term plan as part of the remedies in the lawsuit - providing €119 million for inpatient care provided in selected hospitals to repay suppliers and service obligations. The verdict of the Court of Justice of the European Union in this case had not been delivered by the end of the audit.

One serious problem affecting possible health sector reforms is staff instability in the Ministry of Health. During the six years under review, there have been nine minister changes. At the same time, 36 significant organisational changes were made in the Ministry during this period, with various specialist departments being created, dissolved and transformed, while continuity in the performance of some tasks was not ensured at all. Examples of unmanaged changes include the Office for the Management of Subordinate Organisations and the Institute for Health Policy. The auditors were not provided with official justifications for their disappearance, nor were they left with a professional written agenda. "These two institutions played an important role in the implementation of the actions taken by the Department of Health, which were also based on the auditors' recommendations," concludes deputy chairwoman  H. Crkoňová. The audit also revealed staff shortages in the Internal Audit Service and the Internal Control, Supervision and Complaints Service.

There was also no improvement, and no solutions were found in managing state property. Specific cases have not been resolved. For example, the search for the possibility of continuous financing from the State budget of the SARS negative pressure unit at the Academician L. Dérer Hospital in Bratislava, is intended to treat highly infectious contagious diseases. This facility is currently not functioning due to its state of disrepair. Meanwhile, the Ministry has provided more than 670 thousand euro for service maintenance and reconstruction works in 2018-2023. 

Read the full text of the press release about this issue in Slovak language.