Welfare State Classification: The Development of Central Eastern European Welfare

health insurance (WHO 2004). In other words, the Constitution implied a Beveridgean health-care system, which can thus be considered to be universal and egalitarian.
Unlike Poland, many big reforms have taken place in the period between 1990 en 2005. At the end of
1994 the government approved a document which included the privatization of the health sector.
This led to the privatization of all pharmacies in 1995; primary health-care was privatized in 1996. In
1995 heath-policy documents in which the improvement of the effectiveness, efficiency and quality of health-care is discussed was adopted. In this document the priorities and the tasks of the government were laid down in this document. In 1996, the government approved a health-policy document which proposed measures to contain costs and improve the financial situation in the health sector. In December 1998 the government committed itself to ensuring universal access to good quality outpatient and inpatient care and to controlling and containing health care costs. It stated that these goals could be only achieved by a fast and well prepared comprehensive reform
(WHO 2004: 94). However, one could observe the fact that universal access to the generous scope of free of charge services, which were guaranteed by the Constitution, proved to be unsustainable financially (WHO 2004). In other words, new cost containment measures needed to be developed, or the aim of the health-care system, universal coverage, needed to be changed. Otherwise, the system would no longer be feasible and fundable.
In 2002, the new government developed a radical reform strategy. The overall goal of the reforms was to create sustainable and stable conditions for operation the health sector and to decrease debt.
The reform plan states that it is the responsibility of the Ministry of Health to provide proper and high quality health-care. This means that the delivery and the management of health-care facilities is decentralized, but the state control is still high (Cerami 2005: 98). Thus one can speak of decentralization and centralization taking place at the same time. Again, the 2002 reform plans explicitly stated that the state government was responsible of providing health-care. The reforms also included, again in line with Poland, the stimulation of individual responsibility for one’s own health. According to the WHO (2004) the key-objective of the 2002 reforms was to increase health care system’s responsiveness to population needs having regard for the financial resources available
(WHO 2004: 99). Also, the reform strategy included the fact that health-care provision should be based on contractual structure between health care establishments and health insurance companies, equal opportunities and competition between health care facilities, and an elastic network of providers whose minimum scope will be defined by the state (WHO 2004: 99). Lastly, the reforms of
2002 focused on the decrease of corruption within the system. This is in line with the overall reform context which is based on compliance with European Union norms and the development of a welfare system which ensures economic growth, stability and prosperity.
The WHO (2004) has summarized the development as follows; they state that the Slovak health-care system has been reformed from a tax-based system with a state monopoly in providing and promoting health-care facilities into a system pluralistic and decentralized social health insurance system with a mix of private and public providers (WHO 2004: 107). However, again according to the
WHO, the reforms have not led to increased fundability. Instead it has led to many problems, including increasing internal and external debts. The above means that more reforms need to take place in order to create a health-care system which is sustainable.
However, when looking the developments which have taken place in the last couple of years from a welfare state perspective, one can see a shift towards privatization and decentralization, but at the same time the state wants to keep control of the health sector, the Ministry of Health is responsible, and the coverage is universal. This leads to a very interesting mixture of welfare state aspects; aspects of the liberal welfare state can be observed, while the fact that coverage is universal fits into the social-democratic welfare type. At the same time, one can see some aspects which can be defined as legacies of the communist era: the scope of covered benefits can be considered to be
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wide, almost all services are covered, with the exclusion of a few treatments such as acupuncture, abortion and cosmetic surgery (Cerami 2005: 98).
All in all, the health-care system of the Slovak Republic is interesting when analyzing to what extent
CEE welfare states fit into Esping-Andersen’s welfare state typology. The Slovakian health-care system seems to develop towards a system which combines elements of both the liberal and social- democratic welfare type. At the same time, communist legacies are present. The wide scope of covered benefits can be seen an aspect of the health-care system which is shaped by path- dependency. Again, the mixture of the health-care system which combines elements of liberal, social-democratic and socialist welfare states is a good example of the development of CEE welfare states. More extensive conclusions will be drawn in the following chapter.

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