The context for supply and demand of public online services in Slovakia

Slovakia has a "dual system" of public administration, which means that public administration is divided into state administration and self-government. The most important bodies of state administration are the Office of the Government of the Slovak Republic and the 14 Ministries. The Ministry of Transport, Posts and Telecommunications is responsible for development of the Information Society. Services to citizens and businesses are provided both by the state administration as well as by self-governmental authorities. A process of public administration reform is ongoing. In this context more power and decision making responsibilities are being delegated to self-governmental authorities. In every region (of which Slovakia has eight) and every district there are regional and district offices of state administration. Self-governmental bodies exist on local/municipal and regional level (self-governmental regions were established in 2001).

Key figures about Slovakia[1]

	Slovakia	Ø EU15	Ø EU25
Old age dependency ratio	16.3	25.5	24.5
Population density	109.7	119.8	116.3
GDP per head	54.7	108.6	100.0
Growth - 5 year average	3.85%	1.85 %	1.92 %
Unemployment rate	18.0%	8.1%	9.0%
Inequality index	31	30	29

Slovakia has 5.4 million inhabitants on an area of 49,033 km². The country was part of the Czechoslovak Socialist Republic until the "velvet divorce" in January 1993. The first 11 years of its independence can be divided into two distinct stages. The first stage, lasting about five years, revolved around frosty relations with the European Union and NATO combined with authoritarian rule, disrespect of minorities and lack of economic reform. The second stage saw a complete change of direction and moves to embrace all three - the EU, NATO and economic reform. Admission to the EU came in May 2004.

Slovakiatraditionally had lower income than its neighbouring regions because of the fact that the industrial and commercial core of the CSR was in its western part, which today makes up the Czech Republic. Recent years, however, have seen high rates of economic growth and inflow of foreign direct investment (for example, the banking sector is almost completely in foreign hands) - mainly attracted by low taxation and the business-friendly attitude of the government, as reflected in labour market liberalisation and a 19% flat tax. The unemployment rate, however, has remained one of the highest in Europe - the official rate was 18% in 2004.

Information Society indicators[2]

	Slovakia	Ø EU15	Ø EU25
Households with Internet access	23%	45%	42%
Broadband penetration	0.4%	7.6%	6.5%
Price for Internet use basket	97.49	49.57	48.35
ICT expenditure as percentage of GDP	2.4%	3.2%	2.6%
Digital Divide Index	44.4	53.0	50.1

Slovakia's performance on the UN Telecom Index[3]

Slovakia has sizable ethnic minorities, mainly Hungarians and Roma. The current government has embarked on measures to improve the lot of these minorities, although critics say that there is little tangible sign of progress. The ethnic Hungarian community seeks greater educational and cultural autonomy. The Romany population still suffer disproportionately high levels of poverty and social deprivation.

According to available indicators, Slovakia's development in the Information Society has been roughly in line with its economic development. It lags behind the (richer) Czech Republic, but mainly suffers from similar problems: High prices for Internet connections and, as a logical consequence, low uptake of the Internet - especially as far as broadband access is concerned.

Having said that, the rapid economic growth of Slovakia in recent years - which contrasted to much of the rest of the EU which was pinned down by economic slump - is likely to have diminished the gap towards the more advanced EU countries somewhat. The number of broadband users has taken a leap since 2004, mainly due to more DSL subscriptions. In June 2005, Slovak Telecom (the main national provider) counted already 63,700 DSL customers[4].

eHealth in Slovakia

The healthcare system in Slovakia is currently undergoing a deep and profound transformation. The reform was approved by the Slovak Parliament in October 2004 only, which means that at the time of writing outcomes and impacts of the reform process cannot be properly evaluated yet. The reform seeks to put more emphasis on prevention, motivation (of patients as well as physicians), stronger private sector involvement, and sound financial rules to be applied in the healthcare sector.

Experts believe that to meet these objectives it will be beneficial, if not necessary, to introduce and use eHealth services. However, until now the Ministry of Health Service uses its website mainly for communication with the public. Maybe because the reform process has been first priority in recent years and much effort up to now had to be spent on basic procedural and legal changes, no portal solution providing access to health services is currently available - at least not any that would be supported by the government. The Ministry website only allows citizens to download some forms for printing out.

Health-related administrative transactions have not been implemented yet.

Key figures about the Slovak Health System[5]

	Slovakia	Ø EU15	Ø EU25
Percentage satisfied with own health	65.7%	82.5%	79.8%
Prevalence of long-term illness	29.0%	13.8%	20.0%
Doctors per 100,000 inhabitants	328	233	251
Health expenditure as percentage of GDP	6.5%	7.4%	7.3%

Currently, a fully fledged eHealth portal is therefore missing in Slovakia. Most hospitals have own websites but these do not have the character of eHealth services. Rather they provide names of departments and names of responsible persons at the level of the department. There is a certain number of websites in Slovak language focussing on pregnancy, newborns, chronic diseases and so forth. Some websites have lists of links to homepages of general practitioners, of which there are not many yet.

Only few general practitioners or specialists have their own website. An outstanding example comes from a family doctor (www.hlavaty.net) who also offers the possibility to make an online appointment and obtain advice online.

In general, online interaction between patients and their family doctors is the rare exception. This also applies to online appointment scheduling (for practitioners as well as for hospitals), online diagnosis and prescription renewal.

Phone consultation and after hours services by general practitioners is possible in principle, but usually happens only in the context of a long-term (almost personal) relationship between doctor and patient rather than being offered as a common service to all patients. There are several special phone numbers, e.g. for cases of child abuse (children can call this free service), for abused women and a phone number for direct consultation in case of emergency (how to help with resuscitation, what to do etc.).

With regard to online sale of over-the-counter-drugs, several brick-and-mortar pharmacies have own websites, but these feature only information about location of the pharmacy, contact information, products offered etc. There exists a "First Slovak Virtual Pharmacy" which offers health-related products for online purchase via the Internet (payment using Internet banking), but the product range only includes vitamins, cosmetics, some health products, etc. but no pharmaceuticals.

In general it is fair to say that eHealth services (especially of a more sophisticated character) are underdeveloped in Slovakia. There is significant potential for growth on the supply as well as demand side.

Concerning supply, most physicians are not aware of available technology and its relevance for their profession. Knowledge of ICT and eSkills are low, especially among older generation doctors. A basic problem is the lack of incentives for general practitioners to improve their services, as they are paid by insurance companies on the basis of number of patients they treat alone. Most hospitals, meanwhile, lack the financial resources for even the most basic investments. This is resulting in out-of-date equipment including no or insufficient access to the Internet. Moreover, existing information systems in the healthcare sector are usually not networked.

Satisfaction with National Healthcare System[6]

Concerning demand, the majority of citizens are not aware of potential benefits of eHealth services, which means awareness raising activities and support will be needed to convince them of technology's potential in this field.

User orientation in eHealth services

There is evidence that Slovak adults show high levels of interest in online health services. According to a survey conducted in 2003 by non-governmental organisation "Partnership for Prosperity" 61% of Slovakian adults have an interest in online appointment scheduling. This latent demand is currently certainly not met in any way. There is a lack of an "official" eHealth portal covering a broad range of health related issues (healthy life style, information for specific target groups, advisory services etc.). In general, eHealth services (especially more sophisticated ones) are underdeveloped and there is a significant potential for growth on the supply (e.g. most physicians are not aware of the availability of technology relevant to them, and its potential; most hospitals are close to a financial crisis, with obsolete equipment and technology) as well as on the demand side (citizens are not aware of potential eHealth benefits, governmental support and wide promotion is needed). Most of the available services are on rather basic level (mostly just information publishing), they are not personalised, and hardly user-tailored at all.

Internet Use for Searching Health Information[7]

In spite of the barriers listed above, the future will certainly see an accelerated take-up of end-user eHealth also in Slovakia. One reason for this is that the private health sector (for example private doctors) is competitive, which means that private doctors and other private health service providers seek to gain an advantage by offering better services to their patients. Moreover, the next (younger) generation of physicians and nurses will have better digital literacy skills, which should change attitudes and the capabilities for ICT-based modernisation.

A further factor will be the financial reform of the health care system, which - if it succeeds - will bring sound financial rules, more accountability and personal responsibility, and stronger competition across all parts of the health care sector. eHealth services are not at the heart of the reform process currently, which is reflected by the fact that there is no integrated policy or strategy in the eHealth area at the moment. However, in a second stage improvement of health services delivery to citizens, and innovative ways to achieve this goal, will play a much bigger role. Certainly, citizens demand better services: Satisfaction with the national healthcare system is very low today, for example when compared with the neighbouring Czech Republic.

In the spotlight: centrumzdravia

eUser - the Project

The eUser study is funded by the European Commission's IST (Information Society Technology) programme. eUser is a major research and support project which has set out to provide solid evidence as to users' real needs regarding eGovernment, eHealth and eLearning offers, as well as providing data about their attitudes and the uptake levels of current public online services. The project supports the IST programme to achieve its key objectives of putting the user and his/her needs at the centre of IST developments. It provides empirical information on key public eServices domains -eGovernment, eHealth, eLearning - identified as priorities by the European Council, and assesses the demand/supply match in these fields.

The eUser Approach

To achieve its objectives, eUser addresses both generic user-related issues and domain-specific topics, and develops a globally accessible repository of evidence-based knowledge, methods and best practice examples. It pursues an extensive programme of active knowledge translation, transfer and dissemination supported by sophisticated online knowledge dissemination tools. The knowledge base will consolidate both existing knowledge and approaches, and novel data generated by the project through representative population surveys (demand side) in old and new Member States, and through comparative analyses of readiness to address user aspects of public eServices in each Member State (supply side).

The project is designed in two phases. Phase I - the preparatory phase - has developed a conceptual framework that systematically identifies and cross-references user issues and service characteristics in relation to online public services. An EU-wide population survey regarding the needs, experiences and requirements of both current and potential users of online public services has been carried out in early 2005. Concerning the supply side, information from national public sector environments has been collected, about the degree to which the European public sector pays sufficient attention to user-orientation of online services. Good practice examples regarding user-appropriate online public service provisions are being identified and described.

All these results build the basis and provide content for the eUser interactive online knowledge base and support service which is being set up as an online observatory on user issues. This constitutes the basis for active support services on user-centred topics which are being made available inside and outside the IST programme.

eUser Country Briefs

This document has been prepared by the eUser consortium based on information provided by a National Correspondent (Dr. Tomas Sabol, Technical University of Kosice, Faculty of Economics) as well as secondary data sources such as Eurostat and other Commission Services.

25 eUser eHealth Country Briefs are available in a common format, one for each member of the enlarged European Union. You can access and download these documents in PDF format (for free) from our website.

Notes About the Data Sources Used in This Document