Optimisation of the hospital network reform in Slovakia between 2020 and 2025

Slovakia adopted a comprehensive hospital network reform in 2021 (Act 540/2021 Coll.) under its Recovery and Resilience Plan (RRP), motivated by a fragmented network of small, low-volume hospitals and limited transparency on services, quality and waiting times.

The reform reorganises hospitals into five statutory levels, each defined by a portfolio of medical programmes, maximum waiting times, minimum case volumes and quality indicators. This paper provides a policy and regulatory overview of the reform's design, its content and the trajectory of its implementation.

The reform aims to concentrate complex care, improve clinical outcomes, reduce variation, shorten waiting times and improve efficiency. Although the legislative architecture was largely in place by end-2023, core operational pillars are still unfinished: the quality-indicator decree was only adopted in mid-2025, with first availability for categorisation in 2027; staffing-norm legislation has yet to enter the legislative process; minimum-volume thresholds have been repeatedly revised downward; and no provider has so far been excluded from the network on volume grounds.

The roll-out has been affected by political interference, repeated amendments, delays and politically driven re-categorisations, illustrating the gap between a legalistic design and its political execution. Policy implications stress the importance of aligned payment systems, sustained stakeholder engagement and systematic evaluation against the reform's stated objectives. Outcomes for efficiency, waiting times and treatable mortality will be the subject of future quantitative research as administrative data become available.