This annex provides and overview The Slovak health data infrastructure for the purposes to set up Health System Performance Assessment in The Slovak Republic. Drawing on the comprehensive Situational analysis of the Slovak health data infrastructure for HSPA purposes (OECD, 2025[1]) it describes the main data custodians and data sources highlighted in Chapter 5, with a particular emphasis on health data infrastructure relevant to the final set of 110 HSPA indicators that populate the Slovak HSPA framework. More information and details on the health data landscape is available in the Situational Analysis of the Slovak health data infrastructure for HSPA purposes (OECD, 2025[1]), drafted building on interviews with the health system custodians in 2024 and desk research.
Health System Performance Assessment Framework for the Slovak Republic
The Slovak Republic’s health data governance is primarily anchored in the Act on the Healthcare Information System (2013), which designates the National Health Information Centre (NCZI) as the central health data custodian and administrator of the National Health Information System (Parliament of the Slovak Republic, 2013[2]). The NCZI is the main health data stakeholder in the Slovak Republic, whose role is highlighted in the health data legislation. The NCZI is the administrator of the National Health Information System, which is used to collect, process and provide health information.
Beyond the NCZI, several institutions share responsibilities within the data governance landscape:
The Healthcare Surveillance Authority (ÚDZS) supervises health insurance companies and healthcare providers and maintains key administrative registers, including registers of insured persons, healthcare professionals, healthcare providers and deaths. For this purpose, the ÚDZS publishes methodological guidelines for data collection and collects data for a variety of administrative and technical purposes.
The Ministry of Health (MoH), particularly through the Institute for Health Analyses (IZA), is the largest secondary user of health data and administers datasets for DRG-based hospital reimbursement, risk adjustment and hospital network optimisation.
The Public Health Authority (ÚVZ) methodologically manages, steers and controls the performance of state administration in the field of public health. The ÚVZ and its subordinated Regional Public Health Authorities collect data on communicable diseases, population health surveys for risk factor screening, and environmental health factors.
The three health insurance companies (HICs) in the Slovak Republic gather claims data and have unified master data flows, which is based on methodological guidelines from ÚDZS and the MoH. In addition, the HICs create their own datasets above this minimal data requirement. These datasets primarily relate to quality and efficiency indicators which are used by the HICs in their contractual policy with healthcare providers.
The Statistical Office of the Slovak Republic (ŠÚ SR) conducts the European Health Interview Survey (EHIS), health-related modules of other surveys and reports to international organisations, including Eurostat and OECD. It operates under the State Statistical Surveys Programme which defines the scope of primary and secondary data collection.
The Ministry of Labour, Social Affairs and Family manages social benefit and disability-related datasets relevant to health policy.
The eight self-governing regions collect administrative data on healthcare providers, as part of their processes on issuance and revocation of authorisations for outpatient and inpatient healthcare providers and their facilities. While two regions also operate their own hospitals and manages related data.
The State Institute for Drug Control (ŠÚKL) is responsible for safety, efficacy and quality of pharmaceuticals and medical devices in the Slovak Republic. It collects data on medication safety, volume of reexported pharmaceuticals, and manages list of registered medical products.
The Centre for Scientific and Technical Information, co‑ordinates interdisciplinary research and development centres and national research infrastructures. It manages a variety of datasets related to its core activities, including data on students and graduates.
The Operational Centre of Emergency Medical System of the Slovak Republic (Operačné stredisko záchrannej zdravotnej služby, OS ZZS SR), a directly managed organisation of the Ministry of Health, oversees emergency medical services, including management of emergency calls and co‑ordinating rescue health services. To ensure efficient and co‑ordinated response, it collects data to assess performance and ambulance emergency healthcare delivery. These include the number of emergency calls, timeliness of care provision, occupancy rate of rescue service ambulances, etc.
The NCZI, the ÚDZS, the MoH, and the health insurance companies can be considered the largest data collectors based on the types of information received through the variety of data records (Figure A B.1. ). However, several regular data reports are also requested by the Ministry of Labour, Social Affairs and Family, the ÚVZ, the ŠÚ SR, the ŠÚKL, and the self-governing regions. The NCZI dominates health data management in the Slovak Republic, collecting information for almost 77% of all health data record fields. Main data sources for the datasets at the NCZI custody are the regular reporting from healthcare providers, including reporting into clinical registries, e‑health records, and administrative claims data made available by the health insurers.
By share of health data record fields in their custody
Note: The figure shows data custodians across the healthcare sector and is not limited to HSPA-related data. Based on a scoping review of the health and health-related datasets in the Slovak Republic. In some cases, the data custody is unclear; in such situation, the data record field is assigned to a data custodian based on the data use for administration or analysis, or according to who makes the data, or its aggregates, publicly available.
Source: OECD (2025[1]), “Situational Analysis of Slovakia’s Health Data Infrastructure for HSPA Purposes”.
Numerous data transfers between institutions demonstrate an existing foundation for information exchange in the Slovak Republic, although these flows are primarily purpose-driven rather than organised around systematic secondary use. Healthcare providers transmit data through several parallel channels: to the NCZI via regular aggregate and registry reporting; to HICs through monthly claims batches for reimbursement; to the ÚVZ through communicable disease notifications (EPIS); and to other authorities depending on regulatory requirements. Claims data submitted to HICs are subsequently transferred to NCZI and the MoH, creating one of the main structured data exchange pipelines in the system. Mortality data flow through civil registration and autopsy reporting processes involving the ÚDZS, NCZI and the ŠÚ SR, ensuring validation and official statistical use.
Several additional institutional data flows operate alongside this core channel. ÚDZS maintains and updates the Central Register of Insured Persons and other administrative registers (insured persons, healthcare professionals, healthcare providers), sharing relevant information with NCZI, including for eHealth functions. The MoH receives detailed datasets for DRG-based hospital payment, risk adjustment across insurers and hospital network optimisation, drawing on inputs from providers and HICs. ÚVZ operates the EPIS surveillance system, collecting individual-level data from laboratories and providers. The ŠÚ SR compiles health expenditure data drawing on multiple administrative sources. The Ministry of Labour, Social Affairs and Family manages individual-level data on disability and social benefits, with limited project-based linkage to health datasets.
Datasets differ considerably in terms of clinical depth, provider coverage, timeliness and interoperability (Figure A B.2. ). HIC claims (“batches”) and national administrative registries combine broad provider coverage, relatively timely reporting and the use of shared unique identifiers, making them the most interoperable data sources. By contrast, annual or quarterly thematic reporting relies largely on aggregate submissions without shared identifiers, while population health status datasets and national clinical registries, although often clinically detailed and based on individual-level data, tend to have longer reporting cycles and more variable timeliness. However, overall, although several datasets contain individual-level information and identifiers (masked IDs in claims data; birth registration numbers in certain administrative and surveillance datasets), routine cross-institutional linkage remains limited.
Source: OECD (2025[1]), “Situational Analysis of Slovakia’s Health Data Infrastructure for HSPA Purposes”.
Despite extensive data availability, Slovak health data usability for HSPA purposes could be improved by addressing structural limitations. Figure A B.3. denotes selected elements of the Slovak Republic’s health data infrastructure opportunities, strengths, and areas of improvement vis-à-vis the purposes of the HSPA development. A key challenge lies in limited regular data linkage for monitoring and research. Although many datasets exist, only a small fraction are routinely linked, constraining the ability to conduct integrated analyses across care settings or along patient pathways. Automatic extraction from electronic clinical records remains limited, and some datasets, particularly certain national clinical registries, face processing delays due to manual reporting and validation procedures.
Source: OECD (2025[1]), “Situational Analysis of Slovakia’s Health Data Infrastructure for HSPA Purposes”.
Governance and legal arrangements further restrict effective secondary use. While the Act on the Healthcare Information System provides a framework for data collection and storage, operational mechanisms for sharing data in the public interest remain underdeveloped. In 2024, structured access processes and clear technical entry points were lacking, contributing to siloed data management. Legislative constraints limit broader use of administrative claims and socio-economic data, and safeguards enabling wider analytical access are not yet fully institutionalised, although ongoing reforms under the European Health Data Space and the RISEZ project aim to address these gaps. The RISEZ project (“Expanding the service portfolio and innovating eHealth services”) was launched by the NCZI in 2024 to improve NCZI’s data management system functionality, data sharing capabilities, and reduce workload for data custodians and ultimately for data reporting units (healthcare providers). Implementation of the project and new data collections are expected to be phased in starting in 2026.
At dataset level, some clinical registries experience incomplete reporting and processing delays. Aggregate provider reporting to NCZI does not support patient-level analysis or reliable estimation of incidence and care pathways, and reporting compliance varies across regions and specialties. Administrative claims data, while analytically strong, cover only reimbursed services and exclude certain elements such as laboratory results and uninsured care. Further gaps include the absence of a nationally representative patient experience dataset, incomplete adverse event reporting due to self-reporting, and limited linkage between health and social data, constraining comprehensive assessment of chronic conditions and long-term care.
This section highlights selected sources of data for the Slovak HSPA framework, drawing from the national health data infrastructure and international sources. Almost 80% of indicators in the Slovak HSPA are linked to international sources, such as surveys, international organisation data collections, publications and databases (see Box A.B.1 and Chapter 3), while the rest are sourced from country-specific sources and methodologies.
Many of the selected indicators draw on well‑established OECD and other international data collections that provide comparable, high‑quality information on health system performance. These sources support cross‑country analysis by offering consistent definitions, validated methodologies, and regular updates.
Health Data Questionnaire collects core health datasets, such as insurance coverage, long-term care, pharmaceuticals consumption, risk factors, screening rates and remuneration of health workers. It is managed by the OECD, and conducted annually.
JHAQ (Joint Health Accounts Questionnaire) collects internationally comparable data on countries’ health expenditures, following the System of Health Accounts framework (standards for classifying and monitoring health spending) and jointly administered annually by OECD, Eurostat (available through National Accounts Database), and WHO. It enables detailed tracking of spending by function, provider, and financing scheme.
JQNMHS (Joint Questionnaire on Non‑Monetary Health Statistics) gathers non‑monetary health statistics such as workforce, infrastructure, hospital capacity, and service utilisation and hospitalisation diagnoses, jointly administered annually by OECD, Eurostat, and WHO to facilitate cross‑country monitoring of system resources.
HCQO (Healthcare Quality and Outcomes) is the OECD’s collection of comparable indicators on health care quality, conducted once every two years. It covers dimensions such as healthcare effectiveness, safety, and patient‑centredness to benchmark performance across health systems.
PaRIS (Patient-Reported Indicator Surveys) is the OECD’s initiative where countries work together on developing, standardising and implementing a new generation of indicators that measure the outcomes and experiences of healthcare that matter most to people. It surveys primary care users about aspects like quality of life, physical functioning, psychological well-being and experiences of healthcare.
In addition to the regular data collections listed above, the OECD undertakes work to develop and expand indicators to facilitate adoption of validated common calculation methodologies for indicators that capture specific topic areas, such as mental health, climate, emergency care or cancer. The Slovak HSPA includes indicators for instance from the OECD dementia pilot data collection and the long-term care pilot data collection.
Other internationally conducted surveys and studies such as Gallup World Poll, Health Behaviour in School-aged Children survey (HBSC), CONCORD study, and the European Health Literacy Survey (M-POHL) complement administrative data-based indicators and provide information on health behaviours, risk factors (such as EHIS and EU-SILC surveys), as well as satisfaction with the health system.
These international data sources also provide breakdowns by age, sex, education, income and NUTS2 regions for many indicators, such as those related to behavioural determinants, workforce and care quality, more granular analysis of inequities across demographic, geographic and socioeconomic dimensions.
Health status and mortality data
Health status and mortality data in the Slovak Republic are drawn from multiple administrative and registry-based sources. Mortality information is collected through death certification processes involving healthcare providers, civil registration authorities and the ÚDZS, with validated cause‑of-death data coded according to ICD standards and shared with the ŠÚ SR and NCZI for official statistics and international reporting. These data support calculation of core indicators such as life expectancy, cause‑specific mortality and premature mortality.
The Slovak Republic maintains several national clinical registries administered by NCZI, including the National Cancer Registry, diabetes registry, cardiovascular-related registries, tuberculosis registry and neurological disease registries, as well as population health status datasets covering areas such as psychiatric inpatient care, addiction treatment and reproductive health. While these registries enable estimation of incidence and selected outcome indicators, timeliness and completeness vary, particularly where reporting remains partially manual (notably in the cancer registry). Increasingly, administrative claims data are used to supplement registry-based estimates, particularly for chronic diseases.
In addition, population-based surveys conducted by the ŠÚ SR, including EHIS and EU-SILC, collect self-reported health status, chronic conditions, activity limitations and selected mental health indicators. Behavioural surveillance surveys conducted by regional public health authorities further capture health-related behaviours. In addition to international sources, some national data provide breakdowns by region, age and sex for key health status indicators, such as under-five mortality rate (collected by the ŠÚ SR).
Care quality and patient safety data
Data on care quality and patient safety in the Slovak Republic are primarily derived from administrative claims data and DRG datasets, which together form the core analytical infrastructure. Claims data, submitted by providers to health insurance companies and shared with NCZI and the MoH, include patient-level information on diagnoses, procedures, service dates and reimbursements, with masked identifiers enabling linkage across care episodes. DRG datasets complement this with detailed inpatient clinical and cost information, including case‑mix, complications and reimbursement categories, supporting hospital-level performance analysis. These are supplemented by legally mandated quality indicators published by insurers, as well as surveillance systems including the MoH’s register of adverse medical events and monitoring of healthcare‑associated infections by the ÚVZ.
However, key limitations constrain their use for system-wide performance assessment. Adverse event reporting relies on provider self-notification and is likely incomplete. Quality indicators remain fragmented across insurers. Additional datasets, such as hospital network optimisation data on procedure volumes and waiting times, are not systematically integrated with core sources. As a result, despite the availability of rich administrative and clinical data, the lack of consistent data linkage and integration limits the ability to generate comprehensive and reliable insights on care quality and patient safety at system level.
Care utilisation and accessibility data
Care utilisation and accessibility are mainly captured through administrative claims data, which provide detailed information on service use across healthcare settings, complemented by NCZI aggregate reports on activity of general practitioners and specialists, including numbers of visits and diagnoses. Preventive care activity data (such as vaccine uptake or attendance at preventive check-ups) is also available with a regional breakdown through ÚDZS and ÚVZ collections, enabling a more granular analysis of geographic variation in service use.
Additional data on access to treatment are available through pharmacy and dispensary reporting systems, which track dispensed and reimbursed pharmaceuticals and medical devices. Population surveys such as EHIS and EU-SILC further complement these sources by providing information on unmet needs and access barriers.
Despite this broad data availability, important gaps persist. Aggregate reporting lacks patient-level linkage, limiting analysis of care pathways, while claims data capture only reimbursed care. More broadly, limited integration between administrative and survey data constrains the ability to assess utilisation and accessibility in a comprehensive and coherent manner.
Healthcare infrastructure and workforce
Health workforce and infrastructure data are drawn from multiple administrative registers and provider submissions. The NCZI collects annual and periodic reports from healthcare providers on the number, age structure and specialisation of healthcare workers, as well as data on hospital beds, equipment and selected economic indicators. The ÚDZS maintains registers of healthcare professionals and providers, including licensing information and professional identifiers, while the Central Register of Insured Persons supports denominator calculations. Some of these data can be disaggregated by region, allowing for a more detailed analysis of the geographic distribution of providers.
Level of digitalisation in the system can is captured through data generated by key digital systems, notably the eHealth infrastructure managed by NCZI, including the electronic prescription (eRecept) system and electronic records of outpatient visits and hospital discharges (eVyšetrenie), as well as from administrative claims data submitted electronically by providers.
Self-governing regions maintain administrative information on provider authorisations and service availability. Although individual-level workforce information exists in multiple datasets, fragmentation across registers and limited routine linkage constrain precise measurement of practising activity levels and full-time equivalents. Further, available datasets capture the use of specific digital tools, such as the volume of ePrescriptions or the share of healthcare encounters recorded electronically, but do not provide a comprehensive measure of digital maturity.
Financial status and spending
Financial information is primarily derived from administrative claims data collected by HICs, covering reimbursed healthcare services by provider type and function. These data are transferred to NCZI and the MoH and underpin analyses of healthcare expenditure patterns. The MoH additionally manages an individual-level risk adjustment dataset for revenue redistribution across insurers, as well as DRG-based cost and reimbursement data for inpatient care, although these datasets are legally restricted to their designated purposes.
National Health Accounts are compiled under SHA 2011 methodology, drawing on data from HICs, government accounts and NCZI sources, and reported internationally. Provider-level economic submissions to NCZI include costs, revenues and payroll data. While claims data offer detailed information on reimbursed spending, non-reimbursed services and uninsured care are not fully captured, limiting comprehensiveness.
Prevention, screening, and determinants of health
Behavioural and non-behavioural determinants of health are monitored through a combination of administrative and survey-based sources. EHIS and EU-SILC provide data on smoking, alcohol consumption, obesity, physical activity and self-reported health, with EHIS serving as the main source of risk factor indicators in the Slovak HSPA. EU-SILC, conducted more frequently, complements this by capturing self-reported health status with multiple data breakdowns by demographic and socioeconomic variables. Environmental health monitoring conducted by the ÚVZ includes air quality, water safety and radiation exposure. Data relevant to antimicrobial resistance (AMR) are derived from multiple sources, including surveillance systems coordinated by the ÚVZ on infectious diseases and healthcare-associated infections, as well as data on antimicrobial consumption captured through pharmacy and reimbursement datasets.
Preventive activity data (such as vaccine uptake or attendance at preventive check-ups) is also available with a regional breakdown through ÚDZS and ÚVZ collections, enabling a more granular analysis of geographic variation in prevention coverage. Vaccination monitoring is transitioning toward greater centralisation. Historically, childhood vaccination coverage relied on reporting to regional public health authorities, while COVID‑19 vaccinations were captured through eHealth systems; recent legislative changes enable development of a National Vaccination Registry drawing on NCZI administrative data. Influenza vaccination uptake among older people can be monitored through reimbursed claims data.
Cancer screening coverage for organised programmes (such as breast and colorectal cancer) can be derived from administrative and programme data, while opportunistic screening (e.g. cervical cancer) is partially observable through claims and laboratory data.
References
[1] OECD (2025), Situational analysis of Slovakia’s health data infrastructure for HSPA purposes, OECD, Paris, https://www.oecd.org/content/dam/oecd/en/about/projects/the-oecd-technical-support-to-national-hspa-development/Slovakia-Health-data-HSPA.pdf.
[2] Parliament of the Slovak Republic (2013), Act on Healthcare Information System, https://www.slov-lex.sk/ezbierky/pravne-predpisy/SK/ZZ/2013/153/.