Promoting long-term public health solutions is complicated by politics and its cycles, among other things. Health ministers are limited by a four-year term and have to seek consensus among the various ministries. This problem could be solved in Slovakia by the introduction of a so-called supra-ministerial coordinator for process management in healthcare. In addition, general practitioners should be more active in terms of prevention and risk reduction. Richard Raši, a member of the Slovak Parliament and former Minister of Health, said the above at the 2nd Annual International Panel of the Permanent Conference on Healthcare in Prague.
According to this Slovak MP, public health is a complex and interdisciplinary field. It deals with healthcare from one’s conception to their death. The issue is already pertinent before their birth, as it is bound by the lifestyle of their parents and the environment in which they live. „No other area or sector is as complex and long-term as healthcare,“ Raši said at the conference.
The healthcare sector is currently facing such challenges as an aging population, the turnover of medical staff, the need to build new hospitals and reconstruct old ones, a lack of innovative medicines, problems in the outpatient sector, insufficient levels of prevention and unexpected challenges such as pandemics and energy prices. All this requires changes and necessary reforms.
According to Richard Raši, the problem as well as the advantage of public health policy is many different actors are involved. This includes health professionals and health managers, authorities, local governments, academics, government advisory bodies, pharmaceutical companies, health insurers, NGOs, the media and politicians. He himself has worked in several sectors and positions that viewed healthcare from different angles.
„My view of healthcare from the perspective of a physician or healthcare manager was focused on being able to provide health care. The focus on public health was minimal. When I was then the Minister of Health, I tried to promote some elements related to public health, such as the cardiovascular disease prevention programme. My view of health care was again different from the perspective of mayor or the position of Deputy Prime Minister for Regional Development,“ he explained.
A supra-ministerial coordinator could help
The biggest changes in public health can be implemented by the head of the Ministry of Health. According to Raši, this is complicated by the political cycle, which does not allow for long-term changes. „It’s hard to push for long-term solutions when you’re in the position of a politician who is term-limited and when you want to deliver results in one political cycle. Unfortunately, in Slovakia we are still not able to promote long-term solutions which would require investments now, but their benefits would arise only after several years,“ the Slovak MP says.
So-called “ministryism” also creates problems. Some changes require ministries to cooperate with each other. As a rule, this does not happen, because each minister mainly promotes changes within his or her own agenda. „There is also a problem with the central and regional view of, for example, optimizing the hospital network. It’s a central solution that results in optimized patient flow from diagnosis to treatment. But at the same time, cases are changing from acute to chronic. Yet no mayor will approve the closing of their hospital,“ explains Richard Raši.
According to MP Raši, the political problems in promoting changes in the healthcare sector could be solved by a supra-ministerial coordinator for process management. He said that this person could work directly under the Prime Minister or as their commissioner for prevention. „A coordinator must have two basic traits – trans-departmentality and decision feasibility. Each coordinator must also be able to define what the country needs. In order to be effective, they should fall directly under the Prime Minister,“ the former health minister says.
Healthcare needs a strategy
According to Raši, an essential prerequisite for changes in healthcare is a broad consensus across the political spectrum and actors. In addition, there is a need for clear strategic documents with the participation of all „key players“ and clearly defined strategic steps for the long term. This applies, for example, to the area of prevention, such as regular and systematic screening.
„A more proactive approach by insurance companies interested in a healthier insurance group would also help. General practitioners are again a neglected area in Slovakia. They could be more active in terms of prevention and risk reduction,“ Raši said.
These measures should then result in direct and indirect savings on the costs of health insurance companies and the Social Insurance Institution. „The population will also be healthier and more productive, which creates national wealth and growth in the country’s gross domestic product,“ the MP added.
Miroslav Homola
Photo: Radek Čepelák
