The Slovak society has recently experienced number of front-page stories about patients who were refused payment for innovative, highly expensive drugs by health insurance companies. The stories which attracted a lot of emotions and stirred the public are vanguard of much bigger future troubles in public healthcare.

Scientific progress has been offering new drugs which are able to fight many serious diseases and conditions like cancer, autoimmune or inherited diseases by great leaps.

Unfortunately, these innovative drugs tend to have one ugly feature – they are extraordinarily expensive. A treatment can cost tens of thousands of euros, in some cases hundreds of thousands. Or even more – a drug Zolgensma treats muscular dystrophy and is the most expensive registered drug costing over 2 million euros per treatment. There are also several drugs with a one million euros price tag.

Some of these drugs cure. Some stabilize the condition of patients. Many “just” help to prolong life by adding two or three years and improve the quality of this remaining time, compared to a standard treatment.

New drugs are coming and also the circle of patients who can be treated by new drugs is expanding. For example, only tiny percentage of cancer patients have been indicated to receive innovative treatment (biomedicines, immunotherapy, gene therapy etc.) today.

In few years, this percentage can rise multifold. At least a third of the readers of this article will encounter cancer during their lifetime. This can mean hundreds of thousands of Slovaks who will be indicated for expensive treatment in the upcoming decade or so.

And now pay the attention: There is around EUR 1,200 around per capita per year available in Slovak healthcare system. These 1,200 euros have to pay for doctors and nurses, hospitals, ambulances, drugs… Do you know now where I am heading with this lengthy introduction?

Not communism, nor capitalism or monarchic dictatorship can ensure that every citizen will drive a Ferrari. And innovative drugs are the Ferraris of medicine. The question is, how to provide as many Ferraris as possible and how to divide them among the drivers.

I am talking about the rules dictating who will get the expensive drug and who will not, who would live longer with less pain, and who would not. Just try to put such rules in your election program instead of a more typical “we will provide you with everything” stance and you will see the electoral backlash!

What is the price of one year of human life? What should be counted among the benefits of treatment and what among the costs? Should a child be treated preferably compared to an elderly person? Should public healthcare provide patients with a biosimilar drug instead of the more expensive original, even if it meant treatment adjustments and discomfort for the patient (this was one of the topics of a public debate in Slovakia, but led to nowhere).

Should these rules be rock-solid, or should there be space left for subjective decision making?

There are no correct or ultimate answers for these questions. And there will never be. But we need to talk about them. Our effort to come closer to finding these answers will decide how healthy the public healthcare will be in the future.