401.—MANERA DE PREPARAR EL REPOLLO

Michaela Novakova

University of Economics in Bratislava Faculty of National Economy, Slovakia

[email protected]

ABSTRACT

The illness and the unhealthy way of life are not only unpleasant and can cause serious consequences or death, but also generate unwarranted expenses for patients and their families. Due to the fact that in Slovakia all of us are entitled to free care and the financial resources are limited, there is a possibility of separability and exclusion from consumption. Increased household spending is essential to achieve general health coverage, with a view to sustainable health development. However, healthcare spending is not a cost, but an investment in reducing poverty, jobs, productivity and healthier, safer and fairer societies. The main reasons for the increase in health expenditure are rising prices of medicines, medical equipment, but also administrative costs. Another reason is investment in science and research or the development of the pharmaceutical industry. This is also due to the demographic composition of the population, civilization diseases and the growing demand for better patient information. The aim of our work is to analyze household expenditures in terms of structure, economic status of households and the number of dependent children. We have analyzed whether income levels affect household spending. We focused on the aging of Slovak citizens, its expected future development, the impact on health expenditure and also the view of the financial burden on the elderly. Last but not least, we focused on disposable income and expenditures of Slovak households and in this context we investigated whether we can label health as luxury goods. The article is the output of the VEGA project 1/0251/19 Investments of households in housing and the possibility of their alternative use as additional income at the time of receiving the pension benefit.

Keywords: disposable income, economic impact, healthcare spending, household expenditures 1. INTRODUCTION

The forms of healthcare provision have undergone many changes since the birth of society. At present, healthcare varies from country to country Compared to developing countries, developed countries have a private sector mixed with the public. At present, healthcare in Slovakia is provided free of charge (with some exceptions), the basic package is covered by public insurance, has selective contracting with flexible pricing and is based, for example, on the principles of universal access to healthcare and compulsory health insurance. As far as health care providers are concerned, most are owned by the state The private market has almost all outpatient facilities and several private hospitals (Ministry of Health of SR 2019)

2. STATE HEALTH EXPENDITURES - SLOVAKIA

The financing of health care entities is carried out in cooperation with health insurance companies and is controlled by the Health Care Surveillance Authority. Its main objectives are to maintain the financial stability, efficiency and solidarity of the system. If we look at the financing of health care facilities, the service is provided by state budget organizations (which include teaching hospitals, high schools, youth homes, health institutions), state-funded organizations (funded by health insurance companies; science and research funded by the state and own resources), non-profit organizations providing services of general interest (such as founders' deposits, business income, which must be fully used for the provision of services or

even state subsidies), state-owned joint-stock companies and non-state health facilities funded through a contractual relationship with health insurance companies). The largest part of the sources of funding is public resources. Of these, mandatory health insurance contributions are received by three health insurance companies. They receive contributions mainly from employers and employees, self-employed persons, state policyholders (eg pensioners, students), dividends or voluntarily unemployed. Another important source is the funds of the Ministry of Health, which mainly cover the financing of various operating bodies and hospitals. The source of capital investment is approximately 0.1%. They are obtained by self-governing regions and municipalities from hospitals and ambulances. About a quarter of the resources are private, mainly in the form of investments. If we look at real figures, the state budget expenditures on health care in the last ten years have increased by almost half (Graph 1). Otherwise, this will not be the case in 2019, when it is planned to allocate the highest amount of funds in the amount of EUR 5.2 billion.

Graph 1: State budget expenditures in SR. according to the Statistical Office of the SR

Slovakia is not the only country with rising health expenditure. Rapidly rising global spending in low- and middle-income countries is also particularly evident, with expenditure rising by an average of 6% per year compared to 4% in high-income countries. These expenditures consist of government spending, cash payments (people pay for their own care) and other resources (voluntary health insurance, health programs provided by employers and activities of NGOs). Increased domestic spending is essential to achieve general health coverage and objectives in sustainable development in the field of heal. Looking at the future, Slovakia's health expenditure will grow by 0.8-2.4 billion over the next 50 years. €. At present, the share of population over 80 in Slovakia is one of the lowest in the EU (3%). This share is expected to double by 2038 and to be the highest in the EU by 2080 (16%). “Older age means higher health spending. There are several ways to be not afraid of rising health spending. Firstly, it must be accepted that the health sector generates consumer goods which are subject to the same economic forces as in other sectors. Secondly, it is necessary to limit the health care covered by public health insurance. Third, innovations are unplanned and are based on competition.

The more innovative the system is, the more innovative it will be. Innovation is not only in technology, but also in product distribution. Fourthly, patients need to purchase healthcare legally, which is currently a major problem. And the last advice is that health insurance companies should no longer be 'tax authorities'. They should help patients to purchase health care, ensure their long-term management and resources so that there is no shortage during the crisis(Vlachynský 2018). In 2017, a survey of households' financial burden on health care was carried out. More than half of the EU population reported that the amount their households had to pay for medical care does not represent a financial burden. This was reported by households living in Denmark, Slovenia and Sweden (86%), Estonia (85%) and France (84%). On the other hand, 34% said that health care costs were a moderate financial burden, while 11% said that these costs were a heavy burden for them (Eurostat 2019). In addition to health, social and demographic factors affect health expenditure. Demographic factors also monitor age, which has a significant impact on health spending. As we have already mentioned, one of the reasons for the increase in health expenditure is the aging of the population. The dominant determinant of health care spending is income. If health care is routinely involved in the formation of an individual's health, an increase in health demand will cause an increase in health demand. Assuming that health is a normal good, an increase in income will result in an increase in health demand. While maintaining the ceteris paribus condition, the elasticity of healthcare demand will be directly related to the elasticity of health demand. It is clear that health is a normal good. The question is whether health is a necessity or a luxury good.(Moore, Newmann, Fheili 1992)

3. HEALTH EXPENDITURE OF SLOVAK HOUSEHOLDS

Expenditures of Slovak households on health care include “expenditures on pharmaceutical preparations and products, medical goods, services provided to medical staff in and outside hospitals, incl. services from various therapists. Over the last 10 years, they have increased from € 7.43 to € 10.82 (Graph 2). Interestingly, during the crisis, health spending in 2009-2011 was relatively unstable - they first fell, then rose and then fell again.

Graph 2: Expenditures of households in SR. according to the Statistical Office of the SR

Net money expenditures of Slovak households on health in € In the years 2012 - 2014 (€ 10.05 - € 10.33) payments from own pocket slightly exceeded the OECD average. These payments include the purchase of medicines and administrative costs not covered by health insurance, the scope of which is not always clearly defined. In addition to co-financing prescribed medicines, direct medicines payments and user charges for various services not included in the basic healthcare package, expenditure also includes requests for medical certificates. The amounts that patients pay vary between doctors. Despite the fact that household expenditures declined in 2015, Slovakia was still among the first third of the countries that paid the most for healthcare expenditures from their own pocket of households. This represented up to 23% of the total expenditure financing, which is every fourth euro. An average Slovak spent € 1031 per year on health care. Of this amount, 75% was paid by public sources, the rest was paid by the Slovaks themselves, but the most was spent on medicines. Despite high household spending, only 1% of Slovaks could not afford to pay for healthcare. The main reason for these rising expenditures are diseases occurring prematurely. Compared to other countries, these diseases occur in men at 55.5 years of age, in women it is 54.6 years of life. With an average life expectancy of 73 years for men and 80 years for women, men survive a quarter of their life in disease and women survive one third. It is often the case that households lose the income affected by a more serious illness, as well as the partial income of the person who cares for it. This represents so-called indirect health expenditure. A more detailed specification of the division of household expenditures into - Of all expenditures, most households spent on medical and pharmaceutical products and therapeutic devices. As well as total health expenditures, these have increased from € 5.74 / month per person to € 8.78 / month per person over the last decade. This component accounted for more than 70% of all expenditure. If we look at these cash outlays in more detail, we will find, according to the economic status of the household's head, that most of the health expenditure was on pensioners (see Figure 1, Graph 3-C). Their expenditure in 2013 was € 18.4 per month per person. That was the most of all years. At least it was in 2007, when their expenses amounted to 12.2 € / per month per person. Most of these expenditures are spent on medical and pharmaceutical products and therapeutic devices and least on hospital services.