Go directly to legislation of specific CAM therapies in Slovakia:
Acupuncture – Anthroposophic medicine – Ayurveda – Chiropractic – Herbal medicine/Phytotherapy – Homeopathy – Massage – Naprapathy – Naturopathy – Neural therapy – Osteopathy – Traditional Chinese Medicine (TCM) - Other treatments
The Slovak Republic became an independent state in January 1993 after Czechoslovakia split into its two constituent parts. Slovakia joined the European Union in 2004 (11). Slovakia became a member of the Council of Europe on 30 June 1993 (12).
The legal and regulatory status of CAM and CAM practices
The term Complementary and Alternative medicine (CAM) or similar terminology is not found in health legislation in Slovakia. A few regulations concern or influence CAM
treatments and CAM practitioners.
Two main acts regulate health care and health care providers; Act No. 576/2004 Coll. on healthcare, health care-related services and on the amendment and supplementing of certain acts (249), and Act No. 578/2004 Coll. on health care providers, health workers and professional organizations in the health service, and amending and supplementing certain acts, as amended by later regulations (250). The regulated health professions (medical workers) of interest are doctors, nurses, midwives, physiotherapists, public health workers, medical assistants and masseurs (250).
According to Act 576/2004 Coll §2 (249) “healthcare is a set of professional activities performed by medical workers, “including provision of medicaments, medical aids and dietetic foodstuffs in order to prolong life of a natural person (hereinafter “person”), improve the quality of his/her life and ensure the healthy development of future generations; healthcare includes prevention, dispensation, diagnostics, treatment, bio-medical research, nursing care and midwifery”.
This act does not express that healthcare should be provided exclusively by medical workers. Act 576/2004 §50 article III (249) regulates and recognizes natural springs and natural healing springs including declarations of spa towns and natural treatment spas. The Ethical code- attachment No 4 of the Act No.578/2004 Coll. regulates that “the health worker must not support the activities of non-health workers pursuing an activity which can be performed only by medical staff”(251).
It is unclear how legislation on healthcare and health providers influence CAM treatment practised by non-medical workers. Since practising CAM treatments is not forbidden by law it may be practised by anybody according to the Slovak Constitution. On the other hand, if you do so and harm the individual you can be punished according to the Penal Code- Act No.300/2005 Coll, §162 “Damage to health”(251). Act No 348/2008 Coll. Trades Licensing Act may effect professional (for profit) CAM practice (251).
According to the Act No. 578/2004, and recognized by The Ministry of Education of the Slovak Republic, the medical chambers (associations) manage qualified health personnel, licences and registration (252). Of relevance are the Slovak Chamber of Nurses and Midwives (Slovenská komora sestier a pôrodných asistentiek) and the Slovak Medical Chamber for physicians (Slovenská lekárska komora).
According to Article 50 of Act No. 578/2004 membership of the Slovak Medical Chamber is voluntary (250). Slovakia has harmonized national legislation to the European Union Directives and Regulations since they became an EU member state in 2004. Examples of acts are (252):
- Gov.regulation 212/2004 Coll of 24 March 2004 Coll on the competence of health
- Gov.regulation 213/2004 Coll of 24 March 2004 Coll on continuing education of
- Ordinance of Ministry of Health 366/2005 of 24 June 2005 Coll on the criteria and the
evaluation of continuing education of health professionals.
- Act No. 576/2004 Coll of 22 September 2004 on healthcare, healthcare-related
services and on the amendment and supplementing of certain acts.
- Act No 577/2004 Coll of 21 October 2004 on the scope of healthcare covered by
public health insurance and on the reimbursement of healthcare-related services, as
amended by later regulations.
- Act No 578/2004 Coll. of 21 October 2004 on healthcare providers, health workers
and professional organizations in the health service, and amending and
supplementing certain laws, as amended by later regulations.
A list of changes in national acts is given in the declaration by the Slovak Republic pursuant to Article 5 of Council Regulation (EEC) No 1408/71 of 14 June 1971 on the application of social security schemes to employed persons, to self-employed persons and to members of their families moving within the Community (253).
The governmental supervision of CAM Practices
Since 1 November, 2004, the provision of health care and public health care insurance is supervised by the Health Care Surveillance Authority (Úrad pre dohľad nad zdravotnou starostlivosťou) (254).
Their work is based on Act. No 581/2004 Coll. on health insurance companies and healthcare supervision, and amending and supplementing certain acts as amended (255). The authority applies only to regulated health care personnel, consequently only CAM treatment provided by regulated health care personnel will be subject to supervision.
The reimbursement status of CAM practices and medicinal products
Since 1 January, 1993, the Health Insurance Fund (part of the National Insurance Agency) has ensured compulsory health insurance. Since 1 January, 1995 health insurance companies have executed the collection of health insurance contributions and reimbursement of health care expenditures. CAM is not directly reimbursed.
Act No.577/2004 Coll. on the scope of healthcare covered by public health insurance and on the reimbursement of healthcare-related services, as amended by later regulations, states what treatment is covered by the national health insurance (252, 253, 256).
Acupuncture is excluded from public health insurance system by legislation. Government regulation No 777/2004 Coll. attachment No.2, part I, establishes a list of diseases for which medical services are partially reimbursed or not reimbursed by public health insurance.
On 13 September 2011, the members of the National Council of the Slovak Republic adopted the bill on the scope and conditions of reimbursement of drugs, medical devices and dietary foods covered by public health insurance and on the changes and amendments to certain laws, replacing the existing law on reimbursement of drugs, medical devices and dietary foods – Act No. 577/2004 Coll. At the same time they approved the new act on drugs and medical devices, replacing the Act No.140/1998 Coll.
The above Insurance laws include direct provision for medical treatment in hospitals, special health institutions, specialized facilities for children and spa treatment (ústavná starostlivosť v nemocniciach, odborných liečebných ústavoch a kúpeľná starostivosť). Public (state or regional), non-profit and private health care institutions are contracted by the health insurance agencies (information: Eurostat section S1111211 NMT) (257)
11. EUROPA. Gateway to the European Union; member countries. Brussels EUROPA
Communication department of the European Commission; 2011 [cited 2011 November 3]; Available from: http://europa.eu/about-eu/countries/index_en.htm.
12. Council of Europe. Council of Europe. Strasbourg: Council of Europe; 2011 [cited 2011
November 7]; Available from: http://www.coe.int/lportal/web/coe-portal.
249. The National Council of the Slovak Republic. Act No. 576/2004 Coll of 22 September 2004 on healthcare, healthcare-related services and on the amendment and supplementing of certain acts. 2004 [February 2, ]; Available from: http://www.privireal.org/content/rec/documents/Slovakia_ActNo576_Healthcare_2004.pdf.
250. The National Council of the Slovak Republic. Act No 578/2004 Coll. of 21 October 2004 on healthcare providers, health workers and professional organisations in the health service, and amending and supplementing certain laws, as amended by later regulations. (Zákon č. 578/2004 Z.z. o poskytovateľoch zdravotnej starostlivosti, zdravotníckych pracovníkoch, stavovských organizáciách v zdravotníctve a o zmene a doplnení niektorých zákonov). Brussel 2004 [cited 2012 Januaray 27]; Available from: http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2006:040:0004:0005:EN:PDF.
251. Kapalla M. Email: CAM legislation in Slovakia. 2012.
252. Kapalla M, Kapallová D, Turecký L. An overview of the healthcare system in the Slovak Republic. The EPMA Journal. 2010;1(4):549-61.
253. The Slovak Republic. Declaration by the Slovak Republic pursuant to Article 5 of Council Regulation (EEC) No 1408/71 of 14 June 1971 on the application of social security schemes to employed persons, to selfemployed persons and to members of their families moving within the Community (2006/C 40/03). Official Journal C 040 , 17/02/2006 P. 0004 – 0005. Brussel: EUROPA, ; 2010 [cited 2012 jANUARY 27,]; Available from: http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2006:040:0004:0005:EN:PDF.
254. UDZS (the Healthcare Surveillance Authority) The Healthcare Surveillance Authority (Úrad pre dohľad nad zdravotnou starostlivosťou). Bratislava: UDZS; 2012 [cited 2012 February 2,]; Available from: www.udzs.sk/?lang=en.
255. The National Council of the Slovak Republic. Act No. 581/2004 Coll. on Healthcare Insurance Companies and Surveillance over Health Care and on Amendment and amendments of certain acts (Zákon č. 581/2004 Z.z. o zdravotných poisťovniach, dohľade nad zdravotnou starostlivosťoua o zmene a oplnení niektorých zákonov). Bratislava 2004 [cited 2012 February 2, ]; Available from www.udzs.sk/?lang=en.
256. The National Council of the Slovak Republic. Act No. 577/2004 Coll: Zákon č. 577/2004 Z on the scope of healthcare covered by public health insurance and on the reimbursement of healthcarerelated services, as amended by later regulations. z. o rozsahu zdravotnej starostlivosti uhrádzanej na základe verejného zdravotného poistenia a o úhradách za služby súvisiace s poskytovaním zdravotnej starostlivosti ( Zmena: 720/2004 Z.z., 347/2005 Z.z., 538/2005 Z.z., 660/2005 Z.z., 342/2006 Z.z., 522/2006 Z.z., 661/2007 Z.z., 81/2009 Z.z., 402/2009 Z.z.). Bratislava The Ministry of Health; 2004 [cited 2012 January 27]; Available from: www.health.gov.sk/?zakony.
257. European Commission. Social protection: Slovak Republic; Scheme 4. EUROSTAT; 2012 [cited 2012 19 March ]; Available from http://circa.europa.eu/irc/dsis/esspros/info/data/esspros_public_data/qualitative/Qbase/Slovak_Republic_Scheme4.html