· Published in Caring For Profit

Case Study

Penta in Slovakia : from real estate to private clinics

In December 2020, a dozen policemen dressed in full riot gear entered the headquarters of Penta Investments in Bratislava. The scene was broadcast on national television and via online news outlets. Jaroslav Haščák, one of the five founding partners of Penta, was detained by the Slovak National Criminal police and charged with bribery and money laundering.

Penta is one of the largest investment companies in Central Europe. Founded in Slovakia in 1994, shortly after the Velvet Revolution, it now operates in over 10 European countries. Their management companies are based primarily in Bratislava, Prague and Warsaw, but the company also has offices in Cyprus, Jersey and the Netherlands. Penta owns and develops real estate properties, operates financial institutions and a gambling business, but one of their most substantial investments is in healthcare.

The company estimates that the healthcare sector accounts for over 30 percent of the value of Penta’s portfolio: they own and operate health care facilities and pharmacies in the Czech republic, Italy, Poland, Romania, Serbia and Slovakia.

Notably Penta operates 13 clinics and 17 hospitals in 24 cities of Slovakia, a country of five million people, making them the largest private healthcare provider in the country. But Penta does more than just provide health services: They also own Dôvera, one of the three health insurance companies in the country, as well as Dr. Max, a network of pharmacies.

Some Slovakians think that Penta has too much power. “If someone owns the largest private health insurance company, a network of clinics and hospitals and also produces and distributes medicines… if it’s not a monopoly, I don’t know what it is,” says Peter Visolajský, the head of Lekárské Odborové Združenie or LOZ (the Slovak medical doctors union). He is openly critical of Penta’s influence on the Slovak health care system.

Eduard Maták, the Penta partner who was in charge of the company’s healthcare investments until quite recently, admits that the firm would like to become a significant player in the sector. “As healthcare is a strategic and long-term investment for us, we want to own key assets so that we can make decisions independently and freely,” he said in a 2015 interview with Privatbanka Magazine.

And Haščák’s arrest last December, was connected to his alleged role in influencing political decisions over the management of the Slovak healthcare system.

Healthcare privatisation

Slovakia’s system of publicly-provided universal healthcare that was created by the former Soviet regime had accumulated a debt of €4 billion by the year 2002 (in current €). In addition to the debt, many citizens were also dissatisfied with the quality of healthcare provided. So, the early 2000s, the government of Slovakia decided to embark on a program of privatisation and reform in the hope that competition would lead to a more efficient system. As a result of these reforms, an estimated 80 percent of Slovak healthcare facilities are in private hands today and only a handful of university hospitals are still public.

A couple of years later, a chance discovery led the Slovak intelligence agency SIS to put a wiretap on an apartment in 2006, where high public officials were meeting with powerful people like Haščák. A 74 page long transcript of conversations recorded in the apartment was leaked in 2011, in which the topic of the Slovakia healthcare system was raised repeatedly. Subsequently, in 2019, some 39 hours of audio recordings were also leaked. Penta Investments maintains that the audio recordings are not authentic. (This scandal is popularly referred to as the Gorilla case or ‘Kauza Gorila’ in Slovakia, after the code name of the recordings.)

To date, the only case ever opened in connection to the so-called “Gorilla” wiretap has been against the former counterintelligence chief who allegedly sold the recordings to Penta for €194,000. It was this alleged sale that formed the basis of the arrest of Haščák, who was however released a month later. Following his release, Haščák left his executive post in the company. After Haščák left his position in the company, Maták also announced his departure. In August 2021, the prosecutor general withdrew the the charges against Haščák due to lack of evidence.

Questions of monopoly

Jozef Mathia, Penta’s investment manager for healthcare investments in Slovakia, says that the company does not enjoy a monopoly in Slovak healthcare: “Neither our hospitals and clinics, nor Dr. Max or Dôvera have a dominant position on the market. There is a strong regulator that examines every one of our transactions. Even the European Commission was looking into whether we don’t have a monopoly position.”

This investigation was a result of a complaint filed with the European Commissioner for Competition by LOZ, the doctors union in 2015. “The European Commission replied to us that since this problem did not cross the borders of our country, it should be solved by our institutions”, says Visolajský. A search of the Slovak antitrust regulator’s website reveals 31 Penta-related investigations, but in every case these were dropped or the company won approval of the authorities.

Mathia says this is proof that company has not broken the rules : “Let me say it like this: the regulator does have strong legislative powers. The way they carry out their activities is up to the people.”

Revolving door

Penta has also often come under scrutiny because of “revolving door” by which persons from Penta owned businesses have been hired to work in public institutions and vice versa. To name a few: Ján Gajdoš, who worked for Dôvera, then became the head of the Slovak Health Care Surveillance authority. Marián Faktor, the former head of the public General Health Insurance Company, worked for Dôvera before and after his term at the public health insurer, and Michaela Gajdošová, a former director of the Pharmacy and Drug Policy Section at the Ministry of Health used to be a medicines policy manager at Dôvera. And two former Health Ministers worked for Penta owned businesses prior to being appointed: Zuzana Zvolenská was a board member of Dôvera before becoming a minister, and Viliam Čislák was working for Svet zdravia hospitals before he became minister of healthcare, and then he worked for Pro Care clinics after he completed his term.

Mathia says that this is not problematic. “I would even say it makes me happy. Because an experienced manager from the private sector can bring added value for the state. If I were the Minister of Health, the first thing I would do is to hire all the people from the private sector,” The LOZ union disagrees. “In general, the private healthcare system has its negatives, but in Slovakia it is exacerbated with its connection to politics,” says Visolajský. “The role of the Ministry of Health as a regulator is so completely lost.”

Public vs private

Whether or not healthcare has allowed Penta to play a powerful role in Slovakia, the investments have not been that lucrative. “It certainly does not have as much profitability or return as other sectors,” says Mathia. “In comparison with Western countries, very little money goes into the healthcare sector in Slovakia. Despite that, we manage to create a reasonable profitability and added value for patients.”

Penta hospital patients that we spoke with for this article are for the most part satisfied - many of them were given membership in Penta’s ProCare clinics as an employee benefit by their employers in Slovakia. Mathia adds that Penta has helped Slovakia solve the problem of debt. “We inherited hospitals and clinics in a desolate state, very indebted,” he says. “(Penta) partners have invested their own resources, made basic management decisions and today, those hospitals at least do not create debt.”

But LOZ does not believe profitability to be a valid measure for the quality of healthcare. “It’s absurd. The Slovak healthcare system is evaluated on financial results and not the quality of healthcare” says Visolajský. “Of course I am not against private healthcare, it can also be beneficial. But it must be really well regulated, because it is a very special area where the market forces may not work well.”

Adriana Homolova

Adriana Homolova is a Slovak born Netherlands-based data journalist.

- Mapping the privatisation of healthcare in Europe
- Resources on privatisation of healthcare in Europe
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