Identifier
Created
Classification
Origin
06BRATISLAVA302
2006-04-13 15:55:00
UNCLASSIFIED
Embassy Bratislava
Cable title:  

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

Tags:  ECON ELAB PGOV LO 
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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

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