Bill passed to reduce wait times in healthcare

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Ljubljana – The National Assembly has passed an emergency bill designed to tackle long wait times for health services by securing more money and prepare the system for a more sweeping reform that is to follow. The bill exposed a fault-line between the Left and the rest of the ruling coalition as the former is worried the law could undermine public healthcare.

The law, carried by 48 votes to 27, lifts the cap on the value and number of services that the public health insurer pays in a given year. Health Minister Danijel Bešič Loredan says that all the services that are provided will be paid for. Roughly EUR 200 million is currently budgeted but the figure could rise further.

The unlimited funding will be available to public providers and concessionaires from 1 September this year to the end of 2023. The minister expects wait times overall will be cut by 40% in six months.

The law also creates the basis for financial incentives for extra workload for primary care doctors and their nurses, and special bonuses for doctor’s offices working in disadvantaged areas.

A new body, an office for oversight, quality and investments in healthcare, will be in charge of systematic oversight of wait times. It will be headed by Aleš Šabeder, a former health minister. This is expected to improve the quality of data and give a clear overview of wait times.

Additionally, it will allow an overhaul of the governing councils of public health organisations. They will have fewer members, but they will have more responsibilities and will be paid more.

Health Minister Danijel Bešič Loredan told MPs the bill was the first step of a healthcare reform. At this stage, the ministry wants to acquire accurate data about waiting times and accessibility at the primary level.

However, the Left failed to back the bill because the extra funding will also be available to private practices who have concessions to provide services that are paid for from the public fund, rather than just public hospitals and community health centres, which perform most of the services.

Voting against the bill as the sole member of the coalition while his party peers abstained, MP Miha Kordiš warned of the risk that staff now employed in public hospitals would move to concessionaires with the help of the extra public funds. “The medical lobby will then extort more privileges for more concessions, for more private practices,” which would push the health system further into privatisation.

Other coalition parties and the minister argued that the bill included a number safeguards proposed by the Left. Bešič Loredan said both public providers and concessionaires are part of the public healthcare system.

Meanwhile, the opposition argued the bill would not achieve what it set out to do and was drawn up and put forward in too much haste, fast-tracked through parliament.

Democrat (SDS) Jelka Godec said the bill was not patient-oriented but provider-oriented. Echoing views expressed by doctors themselves, she said bonuses for extra workload for primary care teams would not help as the teams were overworked as it is.

Her colleague Karmen Furman was also critical of the proposal to abolish changes adopted under the previous government on public procurement in healthcare and questioned the proposal to transfer GP’s powers to other health staff.

The SDS voted against also because of changes planned to the appointments of healthcare institution councils, an issue also raised by the public insurance fund ZZZS and some trade unions. The ZZZS does not think the bill will stabilise the healthcare system. Instead of providing additional funds, accurate data on wait times should be acquired first, it said.

Meanwhile, the Medical Chamber as well as the opposition party New Slovenia (NSi) believe that private providers too should be involved to help tackle wait times. Most of NSi members voted against.

The bill was also criticised for not involving public consultation with the parliamentary Legal Service raising issue with its omnibus nature as it changes several healthcare laws, and a lack of clarity as well as undermining the principle of the rule of law.

Despite amendments tabled by the coalition to correct that, the service said a few issues still remained, including the failure to define extraordinary workload that qualifies for bonuses and the fact that only doctors are eligible for the bonus but not other staff.

The Pharmacies’ Chamber was critical of the law for failing to include pharmacy service and address the shortage pharmacy staff and medications, the latter of which erupted during the Covid-19 pandemic.