The Slovenia Times

Health Purse Manager Facing Reforms


"All international comparisons show we have nothing to be ashamed of, but there is, of course, potential for improvement," Fakin told the STA.

An important landmark for the ZZZS was the introduction of a universal and country-wide electronic health insurance card in 2000. Slovenia was the first country to have introduced such a card and the project has won much acclaim at home and abroad.

When Slovenia joined the EU, the ZZZS started providing a free European health insurance card to Slovenian citizens, which covers the EU countries plus Iceland, Liechtenstein, Norway, Switzerland, Croatia, Macedonia, Serbia, Montenegro and even Australia.

The ZZZS was officially established on 1 March 1992, but it took almost two years before it was finally set up. The beginnings of health insurance in what is a modern-day Slovenia meanwhile date back over 120 years.

The institute is the sole manager of obligatory health insurance in Slovenia, which allows the inclusion of everyone with a permanent residence in Slovenia into the country's basic health insurance scheme. Only some 0.5% of the population, which is less than 10,000 people, are not insured today.

Fakin is the institute's third general manager and is currently serving his second term as the boss of ZZZS, which employs 885 people.

A year after the ZZZS was founded, the state introduced private top-up health cover to complement the public obligatory insurance. Whereas 7% of the funds for health care came from supplementary insurance in 1994, this now amounts to 13.6%.

If Health Minister Tomaž Gantar will push ahead with reforms unveiled by his predecessor Dorjan Marušič, as expected, the state will merge the standard and top-up health insurance into a single state-run scheme and introduce a new health tax.

Fakin is somewhat reserved towards the move and said such a "general participation" would be a necessary new tax but its effects must be examined carefully.

He added that supplementary insurance had so far served as a safeguard for keeping the extent of services covered. Since 2009, the institute has managed to save some EUR 50m a year by transferring certain health services to top-up cover.

According to the coalition talks that led to the forming of the current government, the ZZZS may soon face competition in providing obligatory health insurance.

However, Fakin finds this absurd, stressing that to get prices down one needs to boost competition among suppliers, but the institute is a customer in the health care system.

Moreover, he wonders if it is rational to have more insurers for a population of two million, while he also pointed to the European trend of cutting the number of basic health insurance providers.

The institute's first period in the red was 2001-2004, which was due to an increase in pay in health care, the introduction of VAT for medication and medical equipment and other changes on the state level.

The second painful period hit the ZZZS in 2009 with another pay increase coupled by the global economic crisis, which led to a fall in employment and consequently the institute's income, 98% of which comes from levies on salaries.

According to the latest projections, the ZZZS is looking at a EUR 110m shortfall this year and at EUR 270m next year.

To deal with this situation, the institute has prepared a set of legislative proposals aimed at bringing an additional EUR 361m a year into the struggling health purse.

The proposals, which Fakin said would be sent to the government, include measures such as higher contributions for pensioners, the self-employed, farmers and other groups, lower sick pay and the abolition of full coverage for certain types of medication.

Fakin said the introduction of these measures could no longer wait. The system is already starting to fall apart and can last a maximum of another four years, he stressed.

"Health care is in quite a crisis," he noted, pointing to the long waiting lines, diverging standards in different hospitals and bad conditions in a number of hospitals.


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