The outdated and incomplete nature of the registers is largely due to NCZI’s insufficient use of data already available from other sources, instead repeatedly requesting the same data from healthcare providers.

“We must analyse the scope of collected data, link individual data sources together, and not simply burden providers with the constant need to fill in information. There is still significant room for improvement in this area,” stressed Vice-President Henrieta Crkoňová.

In connection with data submission and usability, auditors also approached healthcare providers and data users. According to the survey results, the new NCZI methodology for data provision is not sufficiently clear to more than 37% of respondents. The most frequently cited reasons for failing to provide data were the time demands and the large volume of information required.

The survey also showed growing dissatisfaction among data users with national health registers, mainly due to their lack of timeliness and significant inaccuracies. Methodological guidelines for completing reporting forms only began to be used in 2025, two years later than the deadline set by NCZI in the measures adopted following the previous SAO audit. Operational guidelines for NCZI staff were also introduced with delay. The absence of clear procedures may lead to problems in practical application.

On the other hand, NCZI has taken several steps to reduce the administrative burden on healthcare data providers, which the audit authority views positively. For example, it introduced three methods of electronic data submission. In addition to provider reporting, registers have also begun to be populated using data from the Statistical Office of the Slovak Republic’s death database, records of reimbursed healthcare within public health insurance, maternity and newborn reports, and inpatient care reports.

However, healthcare providers continue to be burdened with submitting data that NCZI already holds from other sources. A gradual shift could be supported by the introduction of the RISEZ project (Expansion of the Service Portfolio and Innovation of eHealth Services), which is expected to enable unified data processing, mutual compatibility of datasets, and efficient automation of processes. The application of the “once-only” principle is expected to reduce administrative burden for healthcare providers.

SAO SR warns, however, that potential technical issues and the attitude of healthcare providers towards structured data reporting could jeopardise the timely implementation of the RISEZ project or even lead to its suspension, as was the case with the eHealth project.

“Our follow-up audit has revealed persistent shortcomings in NCZI’s management and governance of data within national health registers, while also exposing weaknesses in oversight by the Ministry of Health as the authority responsible for health policy,” emphasised the Vice-President of the national audit authority.

She added: “High-quality national health policy depends heavily on the quality and timeliness of data. If, for example, we do not know which type of cancer is on the rise, we cannot effectively direct funding towards its prevention or new treatments.”

The more accurate and up-to-date the data in the registers, the more effective, targeted and efficient national health policy can be, contributing to improved public health and optimal use of financial resources. “Over the past ten years, the healthcare budget has doubled to more than €10.6 billion, and citizens are right to expect high-quality and accessible care in return for these public funds,” Ms Crkoňová underlined.

The national authority for external audit has submitted its findings from the NCZI audits not only to the parliamentary health committee but also to the government. It recommends that the Cabinet require the Ministry of Health of the Slovak Republic to present a strategy for the development of healthcare information systems, along with a solution for data validation that will ensure the availability of accurate and reliable health data for informed policymaking and implementation.

At the end of 2025, NCZI managed a total of 12 registers. There are currently 13 in operation, including: the National Register of Inflammatory Rheumatic Diseases, National Cancer Register, National Neurological Register, National Cardiovascular Disease Register, National Register of Chronic Lung Diseases, National Diabetes Mellitus Register, National Screening Register, and the National Register of Persons Suspected of Neglect, Abuse or Violence, as well as victims of such acts.

Four registers can be considered fully functional: the National Register of Congenital Defects, National Tuberculosis Register, National Assisted Reproduction Register, and, since January 2025, the National Arthroplasty Register.

Under the law, a National Mental Health Register was due to be established from January this year.