Slovak president's fight for life raises health care fears

BMJ 2000; 321 doi: (Published 08 July 2000) Cite this as: BMJ 2000;321:72
  1. Katka Krosnar
  1. Prague

    The standard of health care provided to the president of Slovakia, Rudolf Schuster, has raised questions about the critical state of the country's health system.

    Mr Schuster, 66, developed complications after undergoing an operation for a perforated colon. Five days after the initial surgery, surgeons operated again when an infection set in, but Mr Schuster's condition was aggravated by double pneumonia and then the failure of his lungs and other organs.

    It was decided to transfer him to a specialist intensive care clinic in Innsbruck in neighbouring Austria. However, his transfer was delayed for four hours because the government's plane was deemed to be poorly equipped.

    The president's condition improved after his transfer and his life is no longer in danger.

    Amid domestic and international criticism of the health ministry's treatment of the head of state, particularly the decision to operate at a hospital without a computed tomographic scanner or air conditioning, the prime minister, Mikulas Dzurinda, set up a commission to investigate.

    The case has highlighted growing concerns about the standard of care provided in hospitals. “If the health system can't look after our president what hope is there for ordinary citizens?” asked Martin Simecka, editor in chief of the Slovak daily Sme.

    Ladislav Pazstor, president of the Slovak Association of Private Doctors said: “It is impossible to provide health care to citizens for the $200 [£133] that is spent per head per year. We have good doctors but even the best cook in the world can't cook a meal from a piece of old bread.”

    The country's health system—ranked 62nd of 191 member states in a recent report by the World Health Organization (24 June, p 1687)—is crumbling fast. The problems are caused by a lack of investment and modern equipment, dilapidated hospitals and the 5bn Slovak crowns (£73m; $110m) owed to drug companies by health insurance companies. Debts in the healthcare system total 15m crowns.

    In the past, many of the country's 14 000 doctors have supplemented their average monthly wage of 12 000 crowns (£180) with private work. But a new law enacted this month bans them from working in both sectors.

    Tibor Barta, vice president of the main doctors' union which has 5000 members and which plans a hunger strike in September, said: “Health care is in deep crisis because it is underfinanced. Operations are delayed because there is no anaesthetic, and there is no money to fund treatments such as chemotherapy, then people die. The system is on the verge of collapse.”

    The spokesman for the health ministry, Ivan Garcar, said: “The president received a high level of care.”

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