The population in Slovakia, like in other developed countries, is aging. People are living to a more advanced age, but not in the best health. The healthcare sector therefore needs major systemic changes, particularly in the promotion of healthy lifestyles and prevention. The Slovak former Minister of Health and MP Marek Krajčí said the above at the 2nd Annual International Panel of the Permanent Conference on Healthcare in Prague. In his words, the state should motivate people more to attend preventive check-ups, and should tax alcohol, tobacco, and harmful food to a greater degree.
The former health chief pointed out that the world’s population will age by 10 percent in less than 30 years, with European Union (EU) member states being the worst off. From the current 447 million, the population will fall to 424 million. The number of people aged 65 and over will also rise by 10 percent. At the same time, statistics show that the EU’s working-age population will fall from 265 million to 220 million. The ratio of the working population per pensioner will change from the current 2.9 to 1.7.
„So, it is very clear that a key strategy for healthcare policymaking and prevention will be to ensure an aging population in society that is as active and healthy as possible. Otherwise, healthcare systems around the world are in danger of ceasing to serve their purpose,“ says the former health minister. Healthcare systems are also vulnerable, he said, because of the challenges posed by changing social, environmental, and technological trends.
Prevention and lifestyle changes are key
In Slovakia, people live in full health to only about 56 years old. The average woman has been treated for a chronic disease for 25 years and the average man for 18 years. According to some studies, lifestyle affects up to 40 percent of people’s health, while the healthcare provided contributes only 10 percent. „We should therefore invest in preventive measures and support the education of the population, making them change their lifestyle, which is extremely important and very effective,“ explained Marek Krajčí.
In his words, it is necessary to take measures that will prolong people’s lives in their fullest physical and mental health. „This then feeds back into the system in the form of a higher labour productivity, saved resources on healthcare, and citizen satisfaction,“ he said.
At present, investment in prevention, for example, is insufficient. Within the EU average, approximately three percent of state budgets go to preventive care. In Slovakia, it is one percent.
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„At the same time, interventions can greatly improve the sustainability of our healthcare systems and go beyond the dimension of health policies, because they also intervene in other ministries in the state,“ the former health minister said.
Prevention is effective, as evidenced by a study
At the conference, Marek Krajčí supported the effectiveness of investments in prevention with a study that looked at 51 prevention interventions. They focused on education, health screening, counselling, as well as environmental and public health regulation. They then divided the results of the preventive measures into cost-effective and cost-saving.
„In the category of cost-saving preventive measures, regulatory measures such as taxing unhealthy foods, increasing the tax burden by 10 percent on high-sugar foods, along with colour-coding the nutritional value of food, ranked the highest,“ he described the study’s findings. These included, for example, increasing the tax burden on tobacco products, banning advertising for tobacco products, increasing the tax burden by 200 percent on alcohol, and regulating the salt content of food.
In the cost-effective category, the top-ranked items were restricting junk food advertising for children during prime time, new screening for abdominal aneurysms in men over 65, a community nutrition and exercise programme for the elderly, subsidies for soundproofing homes near roads, and one-to-one advice from a GP aimed at increasing physical activity.
Higher taxes or a preventive check-up calendar
Health policy in Slovakia was supposed to follow a similar course during Krajčí’s tenure at the Ministry of Health. However, he left the ministry after a year in office during the crisis of the government coalition. „We proposed introducing a schedule of preventive examinations and check-ups. If the individual had complied, a bonus would have been paid in the annual health insurance settlement. We wanted to involve every citizen in health prevention,“ he said.
The network of providers who would provide certain types of screening tests should also be expanded. At the same time, it would also introduce an obligation to book patients for these preventive check-ups at a specific time. Some insurance companies have adopted this bonus principle as a marketing tool to attract policyholders. It showed that this increased the number of preventive check-ups by 23 percent for one company.
„In addition to preventive measures, we need to focus on behavioural change, supported by education or an individual approach. The Office of Public Health, in cooperation with patient organizations, should launch a national programme to promote health and educate the population about healthy living. Campaigns with recommendations and measures should be implemented as early as the birth of the child,“ he said.
In his view, raising some taxes is also important. „It may not only have a positive impact on the state budget, but it may also provide longer health to its residents and contribute to the better sustainability of the healthcare system in the context of demographic changes,“ he says.
During his tenure, the Ministry also proposed shifting the focus from institutional to community-based care. In practice, this means opening community centres, support groups, or psychiatric care centres. „Of course, environmental and public health regulations are also important,“ the former health minister concluded.
Miroslav Homola
Photo: Radek Čepelák
