Changing labour market demand and moving up the global value chain requires high-skilled workers. However, the share of adults with high skill levels in the Slovak Republic is one of the lowest in the OECD. Improving the education system would raise quality and better align students’ skills with new labour market needs and help them face further changes in the work environment. The contribution of the tertiary education system to skills improvement is one of the lowest in the OECD. It has to open itself more to the outside world: by easing the conditions for foreign professors and researchers to teach at Slovak universities, promoting internationally respected research and intensifying the co-operation with the business sector. Another challenge is to secure an adequate supply of skilled workers in the face of rapid population ageing and increasing emigration of young high-skilled workers. Ageing of the population will not only lead to shrinking labour supply, but a growing part of the workforce will need to be retrained. Bolstering the supply of skills requires lifelong learning and attracting skilled migrants, including returning Slovaks.

Despite improvements over the past few decades, Slovak health outcomes remain poor compared with most other OECD countries, even after controlling for differences in per capita income and other social, cultural and lifestyle factors. Disparities in access to care and health outcomes between the Roma and the rest of the population are large. Moreover, the health-care system is a source of general discontent because of high out-of-pocket payments, long waiting lists for some medical services and widely perceived mismanagement of public health-care spending. Health-care spending is currently about in line with the country’s standard of living. However, improving the efficiency of this sector is key: meeting the rising demand for medical services in the coming decades while containing government spending to maintain sound public finances will be challenging. The most pressing issues to be addressed concern: enhancing the efficiency and quality of primary care; addressing the shortage of nurses and replacing the large number of retiring physicians; modernising hospital infrastructure and management; further tightening control over pharmaceutical and other ancillary spending; developing a comprehensive strategy for long-term care; promoting better care access for the Roma population; and improving lifestyles through well-designed public health and disease-prevention policies.