SVaLZ services encompass a broad range of diagnostic and therapeutic procedures that assist physicians in determining diagnoses, monitoring treatment progress, and supporting patient recovery. These include specialised facilities processing biological material (laboratory diagnostics), performing instrumental diagnostics or targeted therapy (rehabilitation), as well as departments of pathology and clinical pharmacology.

The audit revealed that VšZP lacked clear and uniform rules for financing SVaLZ services during the reviewed period. In many cases, management decisions were subjective, leading to unequal treatment of providers.

“In practice, this meant that some facilities were allocated financial volumes insufficient to cover necessary specialised examinations, while services exceeding these limits were not fully reimbursed. At the same time, some providers were financially compensated for services not delivered. This was caused by a highly complex system with numerous amendments and non-transparent pricing agreed between SVaLZ providers and the public health insurer,” explained Ľubomír Andrassy, President of the national audit authority.

The SAO does not question the insurer’s authority to decide on financing; however, a model lacking clear rules and verifiable data creates significant risks of inefficient use of public funds and waste within the public health insurance system. A positive finding is that in 2023 and 2024, VšZP ceased recognising unperformed examinations for reimbursement.

The situation was further aggravated by the Ministry of Health’s failure to issue the programme decree on time between 2022 and 2024. This key instrument for systemic financial planning is intended to determine how much funding should be allocated to individual types of healthcare, including SVaLZ. Delays resulted in budget uncertainty and complicated contractual negotiations between insurers and providers. Moreover, the Ministry did not establish measurable quality indicators for SVaLZ, and therefore VšZP did not rank providers, despite being legally required to do so.

Auditors also identified significant issues in obtaining reliable data on SVaLZ reimbursements. Data provided by VšZP and the Healthcare Surveillance Authority (ÚDZS) differed substantially, and the insurer was unable to credibly explain these discrepancies. Despite requests for verification and clarification of data categories submitted to the ÚDZS, VšZP failed to provide adequate explanations. Reliable data are essential for transparent settlement of public funds contributed by citizens. Without accurate data, it is impossible to plan service networks or effectively monitor lawful and efficient use of public resources.

The audit showed that total expenditure on SVaLZ for VšZP-insured patients increased from approximately €424 million in 2019 to over €485 million in 2024, representing a 15% increase. During the audited period, VšZP also significantly expanded the use of unlimited financing, whereby all recognised services are reimbursed without a fixed cap. The number of providers operating under this regime rose from 173 to 375, and the volume of such reimbursements more than tripled by 2024.

“Such conduct by representatives of the public insurer—whose operation ultimately falls under the responsibility of the Minister of Health—represents a failure in financial governance of public health policy and sets a dangerous precedent for debt creation within the public health insurance system,” stated Mr Andrassy.

Despite several years of declared efforts by both the Ministry and VšZP, regional disparities in waiting times for CT and MRI examinations persist. In 2024, patients in five regions waited between 3.42 and 5.33 days for CT scans, while in regions such as Banská Bystrica, Bratislava, and Žilina, waiting times ranged from approximately 10 to 15 days. For MRI examinations, disparities were even more pronounced, ranging from 25.6 to 40 days, with the longest waiting times recorded in the Banská Bystrica, Trenčín, and Žilina regions.

According to experts, timely access to these examinations is a key prerequisite for early detection of serious diseases and successful treatment outcomes. Healthcare is a fundamental human right and a public interest requiring clear rules and state oversight. Health insurance companies—regardless of whether they are publicly or privately owned—are responsible for the transparent, efficient, and economical allocation of public funds derived from mandatory contributions.

“The Supreme Audit Office therefore recommends that Members of Parliament require the Ministry of Health to establish clear financing rules, introduce standardised contracts for healthcare providers, define measurable quality indicators, and ensure continuous verification of data accuracy. Only through systemic reforms can public resources be used effectively and patients gain timely access to necessary examinations without additional charges,” concluded SAO President Ľubomír Andrassy.