Slovak doctors - hooked on prescribing drugs?

Photo: Archives de Radio Prague

In Slovakia last year prescription drugs consumed about a third of the total amount of money spent in the Slovak healthcare system. This figure is three times higher than the world average. The Health Ministry says local doctors seemed hooked on prescribing drugs even when it's not necessary - while patients tend to visit a doctor even for a mild headache.

Slovakia has about 5.4 million people but every year the five Slovak health insurance companies spend about 937 million euro on prescribed drugs. And the figure is going up, says Zuzana Hornikova, a spokesperson for the largest private health insurer Dovera.

"This year it will spend 10-12 percent more on drugd in comparison to 2006. There is a combination of factors that have led to such a situation. First of all price categorization criteria are not set up well by the Health Ministry, then the population is ageing and tends to need more medical treatment. Another reason is that more expensive modern drugs have entered the Slovak market especially in cancer therapy, neurology and psychiatry."

But what about Slovak doctors, do they really mis-prescribe as the Health Ministry claims? Viera Lesakova, the Head of the Healthcare Controlling Department at the largest state owned health insurer, Vseobecna zdravotna poistovna says that it is hard to asses to what extent they do it.

"We can’t generalize but I am convinced there are some who do it. We have found doctors who prescribe antibiotics for flue, for example. On the other hand there are patients who go to the pharmacy to pick up the medicines but then do not take them."

An estimated ten percent of prescribed drugs end up stored in cupboards, untouched until they expire. In some cases patients decide to combine alternative therapies with drugs, changing the recommended dose and complicating the evolution of their disease. Ladislav Pazstor, the President of the Association of Private Doctors says that doctors often lack adequate guidelines to therapies.

"In Slovakia doctors are free to do whatever they want as long as they have their patients’ agreement. We lack protocols saying which steps should be taken in a concrete case. Many doctors do what they remember from medical school. But new drugs and therapies are developed every year and we need to update our approach to the treatment of a disease or another."

Asked to what extent doctors may be tempted to be influenced to prescribe certain drugs by the lobbying of pharmaceutical companies and distributors, Pazstor admits some may be. Health insurance companies have discovered that oncologists, gastroenterologists and psychiatrists tend to be the most active in writing prescription especially for expensive medicines. In case of oncologists, however, it might be justified by the fact that there are no cheap cancer therapies. Eva Kazaszova from Pfizer, a world leading producer of cancer drugs explains why.

"It is very expensive to develop them. We spend 20 percent from the price of every tablet of any of Pfizer’s drugs on research. It takes years to bring a new cancer drug on the market. All currently existent drugs in the world are available in Slovakia but I can’t say whether they are accesible to all cancer patients or not."

Psychiatrists have also found a justification for recommending patients to swallow lots of pills. Yes, talk therapy might replace some of them but there are not enough qualified psychotheraists in Slovakia to do it. Health insurance companies agree that getting patients to pay more might help reduce drug consumption. Such a policy that obliged everybody to pay 50 eurocents for each trip to the doctor existed in Slovakia until last year. Then the current government cancelled it because it regarded the fee as a barrier to access to healthcare for poorer Slovaks.