Boosting Interregional Innovation Investment and cooperation among Health Innovation Ecosystems

Factsheet – Slovakia

Health system overview

Slovakia’s healthcare system is a compulsory insurance-based model with over 80% public funding, supplemented by out-of-pocket payments (~19%) and minimal private insurance (<1%). While healthcare coverage is universal and access is good, the system is strongly hospital-centric, underfunded in prevention and long-term care, and faces workforce imbalances (notably a shortage of nurses). Per capita health expenditure remains among the lowest in the EU (~€1,743 PPP in 2021; 7.8% GDP). Reforms under financial pressure aim to improve efficiency, promote primary care, digitalise services, regulate pharmaceuticals, and invest in hospital infrastructure.

Sources of Funding

• The system is based on compulsory health insurance contributions: employers (~11%) and employees (~4 %) as of Jan 2024, plus special rates for self-employed.
• State budget contributions cover vulnerable groups (children, pensioners, invalids, students, certain church workers).
• Three public insurers operate on a competitive model: Všeobecná ZP (state-owned, ~55%), Dôvera (~32%), Union (~12%).

System Structure & Access

• Universal coverage via compulsory SHI; no gatekeeper enforcement for GPs, leading to high specialist visits.

Key stakeholders:

Healthcare decision-making in Slovakia is centrally steered by the Ministry of Health, with purchasing and contracting delegated to health insurance companies. Hospitals and providers function in a semi-autonomous contractual market, while public agencies manage regulation, health surveillance, digitalization, and pharmaceutical policy. The system remains highly state-regulated with limited decentralization in practice.

Ministry of Health of the Slovak Republic (Ministerstvo zdravotníctva SR)

• The central policymaker and regulatory authority for health.
• Develops national health policy, strategic frameworks (e.g., RRP investments), hospital reform plans, cancer and mental health strategies.
• Responsible for legislation, licensing, pricing of medicines, defining benefit packages, and national health plans.
• Oversees eHealth policy, national public health campaigns, and allocation of EU funds (e.g., Recovery and Resilience Plan: €1 billion for healthcare).
• Supervises major state-run hospitals and national health institutes.

Health Insurance Companies (Public Insurers)

Slovakia operates under a multi-payer social health insurance system:

• Všeobecná zdravotná poisťovňa (VšZP) – state-owned, insures over 55% of the population.
• Dôvera – private, ~32%.
• Union – private, ~12%.

Roles:

• Purchase healthcare services from providers via contractual agreements.
• Negotiate reimbursement schemes and prices.
• Compete for enrolees, though basic benefit package is identical (defined by the Ministry).

Healthcare Providers

• Include hospitals (public and private), general practitioners (GPs), specialists, laboratories, and pharmacies.
• Providers sign contracts with insurers and are reimbursed on DRG, fee-for-service, or capitation basis.
• Many hospitals are state- or regionally owned, but also numerous private facilities exist.

National Health Information Centre (NCZI – Národné centrum zdravotníckych informácií)

• Operates core eHealth infrastructure, manages the electronic health record system (eZdravie).
• Collects and publishes healthcare statistics, supports digitalization.

Public Health Authority (Úrad verejného zdravotníctva SR)

• Manages public health and prevention, epidemiological surveillance, and crisis coordination (e.g., during COVID-19).
• Regional branches oversee local implementation.

State Institute for Drug Control (ŠÚKL – Štátny ústav pre kontrolu liečiv)

• Responsible for regulation, approval, and surveillance of pharmaceuticals and medical devices.
• Conducts health technology assessments (HTA) and pricing negotiations in coordination with the Ministry.

Other Stakeholders

• Parliament (National Council of the Slovak Republic) adopts laws and approves health budgets.
• Professional Chambers (e.g., Slovak Medical Chamber) issue licenses and participate in ethical regulation.
• Municipalities and Self-Governing Regions co-own some health facilities and play minor planning roles.

 Funding  & budget allocation

In Slovakia there are explicit funding lines for digital health and innovation, covering infrastructure (e‑Health platforms), strategic R&D investments, EU co-financed programmes, and systematic HTA to ensure cost-effective adoption. Recent trends show growing insurance and state spending, signalling continued investment in health innovation.

Slovakia is increasingly channelling public funding into health innovation and digitalisation. The main confirmed allocations include:

1. €112 million locked in for eHealth infrastructure (with more planned),
2. ~€1 billion via the RRP for modernization,
3. Additional EU grants via EU4Health, Horizon, ESIF, plus RDI funds.

Care delivery & purchasing

Slovakia’s care delivery procurement is legally decentralised, with individual hospitals and public providers responsible for most purchasing. However, strategic investment and infrastructure projects, especially under EU and RRP funding, are increasingly coordinated or co-financed through central government mechanisms. There is growing interest in expanding joint purchasing to achieve savings, but systemic centralisation is still partial.

Hospitals and Public Providers

Slovakia’s public healthcare infrastructure consists of:

• State-owned university hospitals (under the Ministry of Health),
• Regional hospitals (under self-governing regions),
• Private hospitals, which are growing in number.

Procurement structure:

• Ministry-managed hospitals (e.g. Bratislava, Banská Bystrica) follow central public procurement rules set by the Public Procurement Office (ÚVO), but conduct tenders independently for most routine equipment, services, and infrastructure.
• Hospitals under self-governing regions act autonomously but must comply with national procurement law (Act No. 343/2015 Coll.).
• Joint purchasing consortia are sometimes used for cost savings (e.g. bulk procurement of pharmaceuticals or equipment), but are not systemically applied across regions.

Centralised Procurement Initiatives: In recent years, the Ministry of Health and National Health Information Centre (NCZI) have taken steps to centralise procurement for strategic priorities:

• eHealth infrastructure and IT systems are procured centrally via NCZI or MIRRI (Ministry of Investment, Regional Development and Informatization).
• COVID-19 response (vaccines, protective equipment) was fully centralised.
• The Recovery and Resilience Plan (RRP) introduces partially centralised procurement for hospital renovations, digital equipment, and structural investments (~€1 billion).

Health Insurance Companies’ Role

Health insurers do not conduct procurement themselves but contract with providers and negotiate reimbursement terms. They influence purchasing indirectly via:

• Reimbursement ceilings and price limits,
• Inclusion/exclusion of services or devices in the benefit package,
• Conditional reimbursement for innovative therapies based on HTA assessments.

Pharmaceuticals and Medical Devices

• Pricing and reimbursement are centrally regulated by the Ministry of Health and State Institute for Drug Control (ŠÚKL).
• Hospitals procure drugs via tenders, often individually, although joint procurements are sometimes used.
• For high-cost innovative drugs, the Ministry may negotiate managed entry agreements (risk-sharing) with manufacturers.

There is no official or institutional preference for local suppliers in Slovakia’s healthcare procurement system. All tenders must be open to EU-based suppliers under equal terms. Nonetheless, local vendors may benefit from practical factors, such as language, service accessibility, or familiarity with public authorities. Strategic investments and EU-funded projects are particularly subject to strict non-discrimination rules.

Digital health Infrastructure

National EHR: Electronic Health Book is mandatory since 2018.

Domestic interoperability: Legally required and centrally managed via NCZI.

Cross‑border sharing: Not legally mandated domestically, but technical capability exists via eHDSI for patient summaries and prescriptions.

National EHR: the Electronic Health Book (“Elektronická zdravotná knižka”)

• Since January 1, 2018, the eHealth system (also called “eZdravie”) has been mandatory. All public healthcare providers, labs, pharmacies, and insurers must participate and integrate certified IT systems by this date.
• The EHR, referred to as the Electronic Health Book, automatically records patient data (prescriptions, examinations, vaccinations, summaries, etc.) ● providers must upload data after each medical encounter, independent of patient consent.
• Patients access their EHR via their insured chip card; specialized doctors require a security code for full access.

Interoperability within Slovakia

• Legally, all IT systems must be certified by the National Health Information Centre (NCZI) and comply with connectivity, security, and authentication standards set out in the Act on National Health Information System.
• Interoperability across Slovak regions is mandated: data from any provider flows into a central national database, making it accessible across the healthcare system.

Reimbursement for digital services

Slovakia does not reimburse telemedicine or digital therapeutics under public health insurance. Reimbursement exists only for medical services/products delivered directly (e.g., medications via teleconsultation). Project funding (EU/RRP) supports innovation but lacks continuity through systematic reimbursement.

Key challenges & priorities

Key Pain Points:

Slovakia faces multiple, long-standing structural challenges in its healthcare system. These include financial inefficiencies, workforce shortages, insufficient primary care access, and the growing burden of an aging population. Below are the most pressing pain points and reform priorities:

Aging population & demographic pressure

• Slovakia’s population is rapidly aging, with over 17% aged 65+ as of 2023; projections estimate this will exceed 25% by 2050.
• This shift increases demand for chronic disease management, long-term care, and geriatric services areas currently underdeveloped.
• The number of people of working age is shrinking, putting pressure on healthcare financing and the health workforce.

Financial sustainability & cost control

• Slovakia spends relatively less on healthcare compared to the EU average (~€1,743 PPP per capita ~€4,000 in the EU; 7.8% of GDP vs. ~11% EU average).
• Despite low expenditure, public insurance budgets are under strain due to rising costs for hospitals, drugs, and staff wages.
• Spending is heavily skewed toward hospitals (inpatient care ~28–30%) and pharmaceuticals (~29%), with very low investment in prevention and primary care.

Workforce shortages

• The Slovak health system faces a critical shortage of nurses (~5.7 per 1,000 population vs. EU average of ~9.2) and an aging physician population.
• Many healthcare workers emigrate for better conditions in Austria, Germany, or the Czech Republic.
• Hospitals are often understaffed, especially in rural areas, limiting capacity and increasing wait times.

Hospital-centric care model

• Slovakia remains highly hospital-centric, with weak primary care and prevention
• Patients often bypass general practitioners and go directly to specialists, leading to inefficient service use.
• This contributes to overcrowding in hospitals and long waiting times for some procedures.

Weak digitalization & eHealth utilization

• While a national eHealth system (EZK) exists, usage remains inconsistent across providers.
• Digital health tools, telemedicine, and electronic data sharing are still underutilized, and not reimbursed.

Governance & fragmentation

• Decision-making is centralized, but coordination between the Ministry of Health, health insurers, regional authorities, and providers is often inefficient.
• Fragmented accountability and limited performance monitoring make system-wide reforms slow and politically sensitive.

Reform priorities

• Shift focus from hospitals to strengthened primary care and community-based services.
• Improve health workforce retention and education.
• Expand prevention, mental health, and long-term care services.
• Ensure digital transformation and interoperability of systems.
• Improve value-based purchasing and cost-effectiveness via HTA.

National priorities:

Slovakia has firmly embedded AI-enabled diagnostics, digital health, and value-based, data-driven care in its national agendas. This creates a supportive ecosystem with funding, infrastructure, and institutional backing for innovative healthcare solutions. Providers and innovators aligned with AI diagnostics, personalized medicine, or value-based delivery stand to benefit most from Slovakia’s strategy. Slovakia has clearly set national priorities that can significantly accelerate the adoption of advanced healthcare solutions, especially in areas like AI in diagnostics, value-based care, and digital health expansion. Here’s an overview:

AI & digital transformation as a strategic national priority

• Slovakia’s 2030 Digital Transformation Strategy places AI, IoT, Big Data, 5G and other emerging technologies at the core of economic and social modernization.
• In healthcare specifically, it emphasizes:
  • eHealth expansion, mobility in healthcare, and personalized medicine for precise diagnostics.
  • Promotion of electronic health services, smart health assistants, and citizen access to health and lifestyle data.

Active funding of AI in healthcare

• Slovakia has funded public–private AI healthcare projects, such as:
  • A ~€1 million RRP grant to Powerful Medical for AI-enhanced ECG diagnostics (ACS detection).
  • Other Slovak AI startups (e.g., PMcardio) gaining momentum in clinical diagnosis using AI.
• These initiatives signal national-level support for AI diagnostics, especially in cardiovascular care.

RDI strategy & AI ecosystem support

• The 2030 National RDI Strategy fosters foreign investment in high-tech, strengthening domestic R&D capabilities.
• AI platforms and hubs—like Kinit.sk and Slovak.AI—promote research, education, public‑sector innovation, and networking.

Toward value-based care & health data utilization

• The digital transformation agenda pushes for data-driven public services, including healthcare, aligning with EU goals and enhancing decision-making via real-time data .
• National priorities include developing public-health intelligence, personalized medicine, and patient-cantered outcomes through data analytics.