Health reform outlined

Health staff in a hospital.
Long-awaited health reform measures set out. Photo: STA

Slovenian Health Minister Danijel Bešič Loredan has presented the outlines of healthcare reform, announcing that Finland and Estonia will serve as models to create an effective, digitised and sustainable health system. Top-up health insurance is to be abolished in 2025.

Addressing reporters on 20 January, the minister also presented an analysis of the current state of play in healthcare, which is to serve as the basis for reform measures and which the ruling coalition discussed earlier in the week.

Because of the system is in disarray, wait times for health services continue to grow increasingly longer, the number of people without a named GP is increasing, hospitals are in the red and there are constant demands for higher pay, he said.

Even though the number of staff in healthcare is increasing, the number of doctors is below EU average.

Per capita expenditure for healthcare has been found to be increasing at a faster rate than average pay or GDP. This means that unless measures are taken, the system will run out of money in 15 years.

The minister said there was no oversight of money flows. While hospitals always make losses, other providers, including pharmacies, psychiatric hospitals and community health centres generate a cumulative surplus.

Last year, hospitals cumulatively generated a loss of €93 million, while the other providers generated €217 million in profit. The minister said reasons for that would be thoroughly investigated.

One major aspect of the reform will be digitalisation to make the system transparent, which the minister believes should also tackle corruption risks. Based on the Estonian model, legislation on digitalisation is to be drafted in three months.

The minister said reform of the public sector pay system was one pre-condition for the healthcare reform. By 1 April, a separate pay tier is to be created for healthcare and social care.

The government also plans to structurally reform the Health Insurance Institute (ZZZS), which collects and distributes funds collected through mandatory health insurance contributions. Relevant legislation is to be ready in two months.

The key goal of the reform will be to re-establish basic treatment of patients at the primary level. “That is where 80% of patients must be treated. Pressure on emergency services must be reduced, and secondary and tertiary level specialists must start doing their job.”

General practitioners and paediatricians will be freed of the burden of administrative work, which will be done by other members of their teams. These will also be redefined.

The Health Ministry will get verified data about patients without GPs in six weeks, to see how many there actually are and why they do not have a primary care doctor.

Discussion will be launched about doctors’ patient quotas, where the minister does not rule out an increase. However, the number of GPs should also increase.

Legislation setting out new rules on awarding concessions to private practitioners is to be ready by the end of the year, along with new workload standards for all healthcare workers, so that both could kick in on 1 January 2025.

Oversight, which is now in the hands of municipalities and various professional chambers, will pass into the hands of a new state agency that will form part of the Health Ministry, following the Finnish model.

The minister pointed out discrepancy between the data provided by various institutions. According to the Medical Chamber, there were 1,851 GPs in Slovenia in 2022, while data of the ZZZS and National Institute of Public Health put the figure at 1,085.

The reform will also tackle the increasing expenditure for sick pay, which has gone from €500 million in 2021 to over €700 million last year. The problem lies in different standards applied by the ZZZS, the Pension and Disability Insurance Institute and the Employment Service.

The Medical Chamber welcomed the health reform plans, with its head Bojana Beović commenting that the analysis-based and tested measures and the plan to seek broad consensus would guarantee success of several measures announced.

Meanwhile, the civil initiative called the Voice of People, which has been pushing for a reform to enhance public healthcare, expressed disappointment. They said the plans did not follow key commitments from the coalition agreement or meet the demands set by patients at rallies earlier this month.

They said the minister failed to address the problem of doctors working both in public and private healthcare or financial imbalances which result in doctors leaving to work for private concessionaires. They also said the government did not have a plan how to increase the number of doctors.