Health reform, one of the government's key priorities, is slowly taking shape starting with two bills unveiled by the Health Ministry on 4 April that deal with digitalisation of healthcare and governance of the ZZZS, the country's public health insurer.

Health Minister Danijel Bešič Loredan said the government was looking forward to the 30-day public consultation and is confident a broader consensus on the future of healthcare can be achieved.

He expects the debate to be "exceptionally heated" since the legislation requires a change of mindset but believes that "we are at a point where society is mature enough to quickly recognise selfish vested interests and exclude them from public debate."

New central IT system planned

The health IT system bill creates a new state-owned company to develop and maintain a centralised IT system with which all health care providers will be required to share patient and treatment data.

In place of the existing 80 or so databases, there would be only six broad databases covering all relevant healthcare documentation and other data.

While the legislation will leave existing data at hospitals intact, it will prescribe standards for the flow of data and their structure in the centralised system. It will also give patients the right to determine which data they want to share and who has access to the data.

"I am confident that the majority of the people want comprehensive treatment, but some have valid reasons to conceal some data about their health, for example due to stigmatisation in society," said Alenka Kolar of the Health Ministry's Digitalisation Directorate.

Reform of ZZZS focuses on governance

The bill reforming the ZZZS, which disburses some €4 billion in health insurance contributions to care providers annually, overhauls the management structure by reducing the existing assembly from 45 to 11 members, whereby the representatives of policyholders would retain the majority. The director general would be replaced by a three-member management board.

The government has said the ZZZS, set up thirty years ago, is no longer institutionally fit for the job and no longer fulfils the tasks it is supposed to perform.

Health Ministry State Secretary Tjaša Vidic said the roles of all stakeholders are more precisely defined in order to mitigate a "systemic conflict of interest" and make governance more effective. The state's role would be "more active".

"We think the way the law is written it facilitates a much more active cooperation between the two stakeholders in the health system, the Health Ministry and the state," she said about provisions that she said were "a key element" of the reform.

Social partners gearing up for a fight

Initial reactions from social partners indicate the government may face a significant backlash, in particular to the bill governing the ZZZS, where trade unions and associations of employers play a strong role via their representatives in the assembly.

When the first information about the bill started leaking out, some critics accused the government of a power grab. Others see the ZZZS as a major source of problems due to its sprawling bureaucracy that finally needs to be restructured.

"The desired changes are not a step in the right direction because they weaken the influence of employer organisations by reducing the number of members," said Blaž Cvar, the president of the Chamber of Trade Crafts and Small Business (OZS), after both bills were discussed by the Economic and Social Council.

Jakob Počivavšek, the chair of the Pergam trade union and himself a member of the ZZZS assembly, similarly said that the reduction of the members of the assembly would reduce the ZZZS's autonomy as he accused the government of trying to co-opt the ZZZS. "We think the concept must be fundamentally changed in order to achieve a consensus," he said.

There were fewer complaints about the health IT system bill as there is broad agreement that the health sector must be digitised. There were however questions about the state-owned company managing the system which would formally be outside the public sector.

"We see it as a way to bypass the public sector wage system ... This could create a dangerous precedent and lead to privatisation," said Irena Ilešič Čujovič, president of the Trade Union of Health and Social Care.