The Slovenia Times

Govt Plans Changes in Health Care


The current top-up insurance system, which most Slovenians are enrolled in to ensure that they get full cover, will be abolished in favour of a fully state-run scheme made up of the existing health care contributions plus a new contribution based on income.

Health Minister Dorjan Marusic would not go into the details of the new contribution today, saying only that it would be collected by the Tax Administration and would be based on the amount of income tax paid by the individual.

The new contribution would bolster solidarity in health care and lower the financial burden on the majority of citizens in securing health cover.

A commission which will craft final calculations for the new contribution has been set up and given the job of coming up with the numbers by the autumn, when the government is to debate legislative proposals for implementing the plan.

Marusic reiterated that the overhaul would include cuts to the basket of services provided to Slovenians under the state health care scheme as a means of ridding the system of unessential spending.

Social services, such as funeral fees, as well as non-essential ambulance transport and natural spa therapy that is not an extension of hospital treatment are to be excluded from the list of services paid from the health purse.

A public debate will be held on the proposals for curbing the basket of services, Marusic announced, adding that there were no complaints from cabinet ministers to the proposal to eliminate services that are not strictly health-related.

He said that efforts will be instead made to re-channel some of the saved resources to areas currently neglected, where waiting lines are still long despite improvements in recent times.

Many patients, including cancer patients, are still forced to wait too long for certain diagnostics services, the minister said.

To finance the basket of services envisaged by the Health Ministry under the plan, the state would have to raise an additional EUR 244m per year in addition to the money already collected from health care contributions. This will be done with the new contribution fee, said Marusic.

Some of the funds would also be collected through new duties on unhealthy products, such as sugary drinks and sweets. The aim is to reinvest the money collected from the duties into programmes of prevention.

The plan also envisages restructuring of public health institutions by promoting greater networking and cooperation among them as well as by giving them greater independence in running their affairs.

Health infrastructure would therefore be transferred from the ministry to the institutions to manage, while the ministry would assume a regulative role.

Moreover, the health purse operator, ZZZS, would assume a more proactive role in ordering goods and services in a bid to give it more leverage in price negotiations.

Marusic reiterated that Slovenian health care had not undergone any significant changes for 19 years, in which time the share of public funds needed to keep it afloat has increased and the system has become bloated.

Although the overhaul is expected to take the form of changes to the current health care act rather than a new bill, Prime Minister Borut Pahor reiterated that the importance of the changes must not be underestimated.

"This is by all means a reform - a reform for the better," he said after the cabinet session.

Given the reactions from the social partners - employers and trade unions - the prime minister is confident that the plan enjoys sufficient support.

Pahor said further talks on the plan would be held in August.

The plan has, however, angered insurance companies which provide top-up insurance, who have argued that it could actually lead to patients having to pay out of their own pocket or services.

Rather than bolstering solidarity, the proposed system will destroy it, as patients will have to foot the bill for some services currently paid for by the top-up scheme, the insurers said.

Vzajemna, the country's lone mutual insurer, added that it was still unclear how the new contribution fee would be set or collected.

Zavarovalnca Triglav meanwhile pointed out that the proposal had nothing to do with health care reform, as the amount of funding or how services are funded was not being overhauled.

Instead of dealing with insurance, the state should have focused on the distribution of funds in health care, Slovenia's top insurer said.

Likewise, insurer Adriatic Slovenica called the proposal as not viable financially and poorly thought through.

"The consequences are very predictable: patients will have to pay for more and more services out of their pocket."

In a similar way, the employers are sceptical about the proposal, stating that it does not include any concrete proposals for the rationalisation of the health care.

They also fear that the new contributions would impose an additional burden on the Slovenian economy, further curbing its competitiveness.

Meanwhile, the largest Slovenian trade union association, ZZZS, supported the abolishment of the top-up insurance system and the introduction of income-based contributions.


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