The Slovenian parliament has passed a reform Health Services Act, a cornerstone of the government's health reform efforts which will end the widespread practice of doctors working in both the public and private sectors.

The clear separation between public and private care "ends the harmful dual practice that has weakened the public system for decades," Prime Minister Robert Golob said after the bill was passed on 2 April.

"We are strengthening a system that serves the health of all, not the profit of individuals," he added.

Dual practice ban just one element

The delineation between public and private services prohibits staff employed at public health institutions from also working for private providers, with this dual practice only possible in rare exceptional cases.

Tighter rules also govern additional work in other public institutions or with concession holders, meaning private entities contracted for public services. Staff will however be allowed to work for other public providers, though that will be strictly regulated as well.

Another major change requires concession holders that are part of the public network to operate in a non-profit manner, after several news reports surfaced of providers generating significant profits by performing services paid for with public funds.

This was despite a recent appeal by the ministers of finance and health, urging coalition MPs not to endorse this amendment because the solution would not achieve its purpose.

Moreover, concessions will now be tied to provider ownership and will not be automatically renewed, with new conditions also including adequate staffing that reflects the public financing and workload measurement.

The new bill also allows the government to temporarily cap prices for private-pay services to 150% of the public rate.

Many of the key changes will be phased in over several years.

Constitutional challenge likely

Doctors have been fighting the dual practice ban tooth-and-nail, their two main organisations, the Medical Chamber and the Fides trade union, arguing that this is harmful.

"The reform Health Services Act recklessly encroaches on the freedom of medical work, it further burdens the already overburdened healthcare system and does not solve the key issues in public healthcare," the Fides trade union said.

The union intends to use all legal remedies at its disposal to prevent the legislation from entering into force. It expects the upper chamber of parliament to veto the bill, and it plans to shortly examine the possibility of a Constitutional Court challenge.

Long history of efforts

Passed in a partisan 50:7 vote after most of the centre-right opposition walked out in protest, the legislation caps years of efforts by left and centre-left parties to put the increasingly ailing system back on its feet.

The public system has long been hobbled by staff shortages and inadequate pay, which have undermined standards of care and led to ballooning wait times, and the mixing of private and public care has long been seen on the left as the main source of problems despite assertions by doctors that this is not a major problem.

Conservative parties, on the other hand, have argued that the system could do with more competition. With the support of medical organisations they have mounted several attempts to dismantle the single-payer system and bring in private insurers, none of which have succeeded.

Instead, the Golob government earlier in its term dismantled a system of top-up insurance run by private insurers in favour of strengthening the single-payer system, seeing top-up insurance as a source of weakness in the system.