VZCZCXRO2714
RR RUEHIK RUEHYG
DE RUEHSL #0302/01 1031555
ZNR UUUUU ZZH
R 131555Z APR 06
FM AMEMBASSY BRATISLAVA
TO RUEHC/SECSTATE WASHDC 9735
INFO RUEHZG/NATO EU COLLECTIVE
RUEHC/DEPT OF LABOR WASHDC
RUEATRS/DEPT OF TREASURY WASHDC
RUCPDOC/DEPT OF COMMERCE WASHDC

UNCLAS SECTION 01 OF 03 BRATISLAVA 000302 
 
SIPDIS 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: ECON ELAB PGOV LO
SUBJECT: HELL NO, WE WON'T SEW: SURGEONS ON STRIKE 
 
¶1. Summary.  On April 6, doctors, nurses, and hospital 
workers in Bratislava went on strike, demanding that the GOS 
raise wages by 25 percent and halt the ongoing privatization 
of hospitals.  Within a few days, the strike spread to at 
least 15 hospitals throughout the country.  The doctors, who 
have legitimate reason to fear that restructuring in the 
health sector will cause heavy job losses in the near future, 
are clearly attempting to use the upcoming June 17 
parliamentary elections as a leverage point to pressure the 
government, particularly given Prime Minister Dzurinda's 
continued weak poll numbers.  Many observers have suggested 
that opposition parties, namely Smer, are to some extent 
behind the strike, but there is no clear evidence that events 
have been organized by political parties.  On April 14, the 
regional court in Bratislava issued a preliminary ruling to 
declare the strike illegal in Bratislava.  While the decision 
appears to be a blow against striking workers, the national 
labor action against the government is expected to continue 
into the near future, and the government has little option 
but to stand firm.  End Summary. 
 
On Strike, Pretty Much 
---------------------- 
 
¶2. The current strike led by the doctor's union (LOZ) is the 
largest in a series of labor actions held at hospitals 
throughout the country in recent months.  This action is the 
first one coordinated on the national level, hitting most 
major cities, including Bratislava (five separate hospitals), 
Nitra, Trnava, Banska Bystrica, Trencin, Bojnice, Martin, 
Zvolen, Presov, Kosice, and Bardejov, among others.  Local 
newspapers have reported generally high levels of 
participation, including 880 of 1,000 hospital workers in 
Trnava, with somewhat lower participation levels elsewhere. 
Strike activities have been peaceful, including a 
1,500-person rally in Hviezdoslavovo Square.  Doctors, 
nurses, and other hospital workers have emphasized their wage 
demands, with complaints against privatized insurance 
companies and hospitals taking a secondary role.  Political 
parties have not visibly participated in any strike 
activities. 
 
¶3. The situation is particularly tense at Bratislava's main 
hospital, where the head of LOZ, Martin Kollar, threatened to 
withdraw emergency services if doctors were indefinitely 
suspended for strike activities.  The hospital director 
responded by filing a complaint with the regional court of 
Bratislava on April 8, supported by Minister of Health Zajac, 
urging that the strikes be halted immediately on the grounds 
that they threaten the health of patients.  At least two 
hospitals in other cities have filed similar suits. 
Following the filing, the healthcare supervision office at 
the Ministry of Health received at least three official 
complaints that emergency services had been denied at 
hospitals during the strike, one involving the alleged delay 
of an operation for an infant.  On April 14, Zajac announced 
that, based on the complaints filed at his ministry, the 
Bratislava court has reached a "preliminary ruling" declaring 
the strike illegal in that city.  The decision has to be 
reviewed and it is unknown how many days or weeks are needed 
until the ruling would become an enforceable injunction. 
 
¶4. Aware that their actions would soon be challenged in the 
courts, strikers have generally been careful to provide 
continued emergency health services.  Newspaper reports 
indicate that doctors on strike have been consistently on 
call for emergency situations, while canceling routine 
appointments.  Many doctors and others are working regular 
hours in the hospital but are officially on strike and 
therefore not receiving pay.  Noting the relatively moderate 
stance of the strikers, the GOS outside of Zajac has been 
unsympathetic but not strenuously or vocally opposed.  Prime 
Minister Dzurinda said on April 12 that, "neither the 
government nor any of the coalition parties is a party to 
this dispute.  That's why we do not want to intervene through 
either statements or comments."  On the strike's legality, 
President Ivan Gasparovic differed from Zajac, declaring the 
strike "legal, as long as the health of the patient is not 
compromised."  Diverse opposition figures ranging from 
Vladimir Meciar of HZDS to Robert Fico of Smer have made 
statements similar to Gasparovic on the strike's legality. 
 
Slovak Health Care 101 
---------------------- 
 
¶5. Doctors and health workers are striking primarily to gain 
higher wages, but also to roll back the privatization of 
hospitals, which is seen as the underlying cause for wage 
stagnation and job insecurity.  In 2003, the GOS began 
restructuring of the health system by converting its state 
 
BRATISLAVA 00000302  002 OF 003 
 
 
health insurance plan into a series of joint stock companies. 
 75 percent of Slovaks are covered by companies owned by the 
GOS, while the other 25 percent are covered by companies 
owned by Slovakia's largest private equity fund, the Penta 
Group.  Small user fees were also introduced at this time, in 
which patients pay 20 koruns (USD 0.70) per doctor's visit or 
prescription.  While these reforms are credited for reducing 
the large debt load incurred by Slovak hospitals, they have 
also created a new, increasingly unpopular form of 
administrative bureaucracy, and have caused unease among both 
doctors and patients.  During the ongoing second stage of 
reform, Slovakia's 75 hospitals are to be converted to joint 
stock or limited liability companies; this process began in 
2005 and it is legally mandated to conclude by the end of 
¶2006.  16 have already been privatized thus far, including 
many hospitals with workers who are participating in the 
current strike.  After privatization, corporations will have 
greater flexibility to liquidate non-profitable hospitals, 
particularly those in smaller towns which have relatively 
high numbers of beds, doctors, and nurses per patient.  The 
first such hospital closing took place in the small town of 
Zeliezovce in November 2005, and more are expected. 
According to the Health Policy Insitute, Slovakia's occupancy 
rate of hospitals in 2004 was approximately 64 percent, well 
below the OECD-recommended optimal level of 90 percent. 
These figures suggest that approximately 25 percent of 
Slovakia's hospitals could reasonably expect to be shut down 
in upcoming years, depending on local occupancy and staffing 
circumstances.  Such changes would significantly reduce 
Slovakia's health care employment numbers, which have already 
fallen from 121,000 in 2000 to 96,000 in 2005. 
 
¶6. Although the threat to job security seems more acute, 
doctors and nurses have focused on increasing their wages by 
25 percent.  In Slovakia, hospital doctors earn $1,000/month 
and nurses earn $300/month.  Salaries increased significantly 
from 2000-2002, and have nearly flatlined thereafter.  While 
wages have not kept up with the cost-of-living in recent 
years, the salaries of doctors relative to GDP per capita are 
very competitive in the region, much lower than Germany, 
roughly equal to the Czech Republic, and higher than Hungary, 
France, and many other European countries.  Total health care 
expenditures have risen roughly in proportion to GDP growth, 
with health expenditures comprising 5.9 percent of GDP in 
2005, the vast majority coming from public expenditures. 
Unfortunately, prescription drug costs have gobbled up much 
of the limited increase in health expenditure, rising by 12.7 
percent in 2005.  Most of the rest of public expenditure has 
focused on modernization of medical facilities rather than 
wages of health providers. 
 
Fool's Gold 
----------- 
 
¶7.  Given the weakened position of Prime Minister's 
Dzurinda's government, the upcoming June parliamentary 
elections, and Health Minister Zajac's seemingly vulnerable 
position as a politician without a party, doctors and health 
care workers undoubtedly believed that the government could 
be leveraged into making concessions.  They also may have 
believed that they could secure a quick statement of support 
from SMER and other opposition parties.  Neither goal is as 
easy as it seems, however.  The GOS views health care reform 
as one of its centerpiece policy initiatives and will be 
loathe to make changes before the elections, lest it look 
weak in the eyes of the electorate.  And, besides, the 
government still has other cards to play.  Firstly, the 
preliminary court decision reached in Bratislava regional 
court on April 14 has recent precedent.  When railway workers 
went on strike in 2003, the High Court ruled the strike 
illegal, finding that railway lines are a sensitive industry 
in which strikes shall not be permitted.  If this scenario 
plays out again on the national level in the health industry, 
the GOS can strategically take no official position on the 
workers' demands while the legal system backs up their 
unspoken position against the strike. 
 
¶8. Also, it is unclear just how strongly the doctors' 
position is supported by the general public.  While concern 
about healthcare reform is widespread, hospital doctors are 
widely seen as slightly corrupt, often accepting 
under-the-table fees for services, and most people believe 
that doctors need to be put under some sort of competitive 
pressure to be more accountable.  Over the past week, 
websites for both SME and Novy Cas have run online polls to 
gauge whether its readers support the strike; while these 
samples are self-selecting and obviously unscientific, it is 
interesting to note that each poll is running nearly 50-50, 
with higher-than-normal levels of participation.  As the 
strike continues and everyday health services become less 
 
BRATISLAVA 00000302  003 OF 003 
 
 
available, it would not be surprising to see public support 
levels drop further.  In such a case, the GOS would be under 
little real pressure to act. 
 
¶9.  Even Smer has kept some distance from the strikers, who 
might be considered a natural constituency as critics of the 
government.  In a press conference shortly before the strike 
Fico declared that, "Slovak healthcare workers and patients 
have been taken hostage by the Dzurinda government, the 
failure of healthcare reform and Mr. Dzurinda's inability to 
admit fundamental mistakes and take the necessary temporary 
measures to avoid the situation spilling over into all-out 
strike."  Then a few minutes later he urged the doctors not 
to go on strike, because it could jeopardize patient health. 
In subsequent public statements, Fico has been fuzzy about 
his plans for the health care sector, signaling a generalized 
support for raising wages but not embracing the full LOZ 
platform.  One of Fico's key advisors was more specific, 
announcing before the strike that he believed health care 
sector wages should be increased but adding that about 20 to 
25 percent of hospitals nationwide will eventually have to be 
closed, regardless of privatization.  In turn, there has been 
no tangible evidence of Smer presence at health workers' 
protest rallies or press conferences -- that is, no Smer 
speakers or references, no signs, no t-shirts.  It seems that 
Smer has decided it will benefit most from the strikes 
against the government by applauding from the audience rather 
than by leading the charge. 
 
Outlook 
------- 
 
¶10. The short-term outcome of the strike is difficult to 
predict, particularly since the impact of the "preliminary 
ruling" by the Bratislava court is not yet clear.  In any 
case, labor strife between hospitals and their workers will 
continue until some sort of agreement is reached; an 
injunction would strengthen management's hand but not decide 
the issue.  The long-term political fallout of the strike is 
also difficult to assess at this point, given the 
non-commital positions of most major politicians, and the 
fact that the strike is still in its relatively early stages. 
 Post will continue to monitor the situation and report on 
it, with a particular eye to effects on the upcoming 
election. 
 
 
 
 
VALLEE