HELL NO, WE WON'T SEW: SURGEONS ON STRIKE

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