Weakened Slovak health minister undermined by Fico in budget consolidation row

The Slovak government announced budget consolidations to reduce the deficit; the move will significantly impact healthcare. Health Minister Zuzana Dolinková (HLAS) faces ongoing criticism from her coalition partners and the opposition - her role remains at risk.

Slovak Prime Minister Robert Fico and Finance Minister Ladislav Kamenický introduced measures to improve state finances by €2.7 billion.

Healthcare drew the short straw as €259 million was cut from the healthcare sector, which was primarily allocated for healthcare workers' salaries. Instead of the initial 9.7 per cent increase, the wages will grow more slowly, just by 3 per cent.

As part of the consolidation, the standard VAT rate will be increased from 20% to 23%, while the VAT on medicines and healthcare products will decrease from 10 to 5 per cent. 

“Personally, I think that the consolidation of public finances should not have affected the already heavily strained healthcare system,” Health Minister Dolinková wrote in a statement.

The interventions still need to be approved by parliament - the vote is scheduled for Thursday.

Consequences

The opposition, Freedom and Solidarity, warned against three main issues related to the consolidation in healthcare: an increased exodus of healthcare workers abroad, longer waiting times, and higher patient fees.

“Nearly €260 million are to be taken from healthcare. The money that was supposed to go toward healthcare workers’ wages will not flow into the sector. Minister Dolinková said that she acknowledges it and is not fighting for her sector,” MP Dr Tomáš Szalay (Freedom and Solidarity) said at a press conference.

He added that it is another reason she is facing a no-confidence vote.

“We believe it is very unfortunate to cut salaries for all healthcare workers this way and effectively stabilise them at zero increase when accounting for the inflation we have here,” MP Peter Stachura (Christian Democratic Movement) said in response to the announced consolidation measures.

Health workers are exploring their options.

"Doctors are prepared not to work forced overtime and on-call hours beyond the legal limits. Healthcare workers are the only employees in Slovakia whose agreed salary adjustments are being reduced by the government as part of the so-called consolidation package,” the Medical Trade Union Association (LOZ) wrote in a statement.

LOZ warns that if the Slovak government implements the publicly discussed plan, Slovakia will again become one of the largest exporters of healthcare workers to other countries, deepening the shortage of nurses and experienced doctors in Slovakia.

“We remind the Prime Minister of his responsibility for our healthcare system. The steps taken by his government do not improve the state of Slovak healthcare and the quality of patient care; on the contrary, they worsen it and make it less effective and sustainable,” the head of LOZ, Dr Peter Visolajský, added.

The Slovak Chamber of Nurses and Midwives also expressed dissatisfaction and rejected the consolidation measures, which threatened the salary growth of nurses, midwives, and healthcare workers.

“Nurses and midwives refuse further experiments from the authorities and interference with their social security. We call on the government to stop gambling with citizens’ health and prevent our nurses from leaving for abroad,” said the Chamber’s statement.

Friendly fire

During a recent press conference, PM Fico, who did not break ranks for ten months, publicly criticised someone from his cabinet for the first time. 

The Prime Minister made it clear that Health Minister Dolinková must present a realistic plan for the functioning of healthcare, stressing that she bears full responsibility for the sector. "If the Health Minister cannot manage it, someone else has to," he said. 

He further challenged the ongoing financial support for healthcare, "How long will we keep pouring money into healthcare without seeing any results? This is a question for the Minister."

The only other coalition member who openly and continuously criticised Minister Dolinková was the leader of the Slovak National Party (SNS/ID), Andrej Danko.

Danko was critical again during a political debate programme: “Simply put, we have non-conceptual work here, and it must be said that the biggest pit where money disappears is healthcare.”

“I strongly object to the claims made by the leader of SNS, Andrej Danko. Mr Chairman clearly has absolutely distorted and partial information regarding the functioning of the Ministry, which, unfortunately, he does not understand,” the Health Minister hit back on Facebook.

Coalition partners SNS and HLAS traded multiple body blows on social media, and the Minister’s tenure is now in real jeopardy.

MP Szalay urged SNS to demonstrate their dissatisfaction by supporting their opposition proposal, “On the agenda of the current parliamentary session is a proposal to recall Minister Dolinková. MPs from SNS have the opportunity to vote in favour and support the removal of this incompetent Minister.”

[Edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy Lab]