Sick pay in Slovenia will be capped and the period of sick leave that is paid for by employers will be extended to help shore up the public health insurance fund under an emergency bill passed by the National Assembly on 14 December, shortly before top-up health insurance is merged into mandatory contribution.

Parliament already passed in summer legislation that phases out supplementary health insurance, a flat-rate monthly payment that is voluntary but needed for most health services. So far collected by private insurance companies, it will merge with mandatory health contribution starting from 1 January 2024.

The mandatory contribution will remain at a fixed amount of €35 a month, with the possibility of adjustment once a year, but since the costs of health services have been rising and private insurers have been arguing that the amount does not cover the costs, the government is to chip in up to €240 million in 2024 to cover for potential shortfalls.

Projections recently presented by the ZZZS, the public health fund manager, indicate that the fund's expenditure in 2024 will amount to €5.35 billion and that even with the €420 million transferred from the government budget there would still be a deficit of €144 million.

According to Health Minister Valentina Prevolnik Rupel, the prime aim of the emergency bill is to provide certain legal bases for the new mandatory contribution. One of such is that the state will pay the insurance of all under 18-year-olds.

However, the bill also includes a number of other changes to several laws that the minister argues will improve the organisation of the healthcare system but which raised controversy among the social partners.

Extra money for health fund

In a bid to provide extra funds for the health insurance fund, the bill caps sick leave compensation at 2.5-times the average pay. This affects only those with the highest earnings. Official statistics quoted by the ministry show that last year 2.3% of all employees earned as much as to be affected by the cap.

The ministry also proposed reducing sick leave compensation to 80% of an individual's pay after 90 days of sick leave, but along with several other controversial provisions, MPs threw that out, which means employees will continue to be entitled to 90% of their pay while on sick leave.

Data presented earlier this year by the ZZZS and quoted by PM Robert Golob as an argument for change is that sickness absenteeism cost the public health fund almost €700 million in 2022. In this year's financial plan €658 million is projected for sick pay.

Sick leave is not limited in Slovenia and nor has the amount of compensation been so far, with ZZZS data showing that in 2022 the longest absence due to sickness had been almost 12 years and the highest monthly compensation paid was €22,546 gross. In November 2023 average gross pay was €2,174, which would put the maximum sick pay at €5,435 gross.

The bill also reintroduces a longer, 30-day, period during which sick pay is covered by the employer after this period was shortened to 20 days in January 2022 but proved to be too much for the public health purse. The government expects this will save the health insurance fund €73 million a year.

This provision met with harsh criticism from employers, who see it as yet another tax burden imposed on businesses. The opposition unsuccessfully sought to push through an amendment to strike out the extension of the employer's liability.

Provisions that irked doctors

The original version of the bill adopted by the government caused a furore among doctors over an article that they saw as giving the Health Ministry the power to force them to work for other institutions in the event of a shortage of healthcare staff because the conditions were vaguely determined.

The minister was quick to acknowledge that the provision entailed ambiguity and MPs reworded it by an amendment so it now specifies that reassignments are possible only under extraordinary circumstances such as natural and other disasters, while there is no mention of staff shortages any longer. Such deployment is limited to 12 consecutive months.

The MPs also threw out an article that would have prohibited doctors with a concession from transforming from sole proprietors to limited liability companies.

Meanwhile, all doctors will have to be included in the stand-by services to provide round-the-clock emergency medical aid, including concessionaires. So far only primary care doctors and concessionaires had to be included.

Even if some of their grievances were heeded, doctors are still unhappy. Medical Chamber head Bojana Beović argued it was unfair that work obligation, cancellation of annual leave and employee reassignments in case of a natural disaster only applied to healthcare staff but not those in other sectors as well.

Trade unions and organisations representing doctors also argued that systemic changes had no place in an emergency bill and should be subjected to social dialogue, which was not the case now as the government was rushing to get the bill through in time for the changes to health insurance to be able to kick in. The minister hopes the upper chamber will not veto the bill, so it can take effect on time.

Measures to deal with staff shortages

To deal with staff shortages, the bill includes measures to cut red tape involved in hiring of healthcare staff from abroad, including an extension of lower language requirements for graduate nurses, midwives and pharmacists.

It also extends a measure under which medical students opting for family medicine are eligible for a bonus.

Moreover, it significantly increases bonuses for extra workload of general practitioners in public health institutions. Doctors will be eligible for €1,500 gross per month, nurses with a graduate or undergraduate degree €750 and nurses with secondary school €600.