Slovenia Health Profile 2012

Since 1992 Slovenia has had a Bismarckian type of a social insurance system based on a single insurer for statutory health insurance, which is fully regulated by national legislation and administered by the HIIS. This insurance is universal and based on a clear employment status or on a legally defined dependency status (such as minors, unemployed spouses, registered unemployed people and individuals without source of income). Experts from the Ministry of Health have a supervisory and controlling role within a system, which has been gradually decentralized through a number of tasks being assigned to different stakeholders. Since 1992, the previously exclusively publicly financed system has been transformed into a mixed system where private sources of funding have become significant, reaching 27.8% in 2006 (Statistical Office of the Republic of Slovenia 2009). This has been achieved by financing some expenditure from co-payments and complementary insurance. Co-payments have never become fully effective incentives for lowering utilization, as most of the adult population took out complementary insurance, which accounted for a 13.8% share of total health expenditure in 2006 (Statistical Office of theRepublic of Slovenia 2009).
Some of the previous tasks for which the State was responsible have been assigned to professional associations, called zbornice (professional chambers), which control qualifi cations, specialty training and continuous education.
Another important feature of today’s health system in Slovenia is the growing share of private providers, especially in primary and specialist health care. This has led to increasingly complex contracting arrangements, as privatization is associated with fragmentation in provision. Most of the care delivery is still carried out by state-owned (hospitals, most of outpatient specialist care and tertiary care) and municipality-owned providers (primary health care centres), who collectively employ more than 75% of the total health workforce (IPH-RS 2006b). Only for dental services does the share of private providers exceed 50%, with 12% of all providers working exclusively for out-of-pocket (OOP) payments (IPH-RS 2006b).

Organizational overview
The main organizational features of the Slovene health system, along with the key actors and their relationships are derived from the historical development of the health care system and are based on legislation. The Health Care and Health Care and Insurance Act of 1992 set out the basis for the system of compulsory health insurance and VHI in effect at the time of writing, as well as permitting privatization of health care services and transferring many administrative functions to the Medical and Pharmaceutical Chambers. At the state level, the Government is responsible for assuring the necessary conditions for a healthy environment and healthy living, as well as for the
implementation and functioning of preventive public health programmes and health promotion.
The State, via legislative and executive bodies (ministries, state agencies and offi ces) has administrative and regulatory functions. The State can pass laws and by-laws, as well as implementing standards and other mechanisms to assure the prevention of contagious diseases, a health-friendly environment, protection and health in the workplace. Other responsibilities include establishing special programmes on preventive activities, providing care and protection for the most vulnerable population groups, and generally determining the policy of health care. Important among these are public health care tasks, planning development in the fi eld, and the establishment of priorities. Furthermore, the State is the owner and administrator of public health facilities at the secondary and tertiary care levels. The aforementioned tasks are implemented by the National Assembly, the Government and its individual ministries.

National Board of Health
The National Board of Health is an advisory body to the Government and is responsible for retaining health as an agenda matter of consideration in governmental and parliamentary procedures. As defi ned by the Health Care and Health Insurance Act of 1992, the Board’s role is to support health policy by monitoring the effects of the social and physical environment on health; it evaluates the development of plans and legislative drafts from a population-based perspective. For this purpose, the Board cooperates with administrative bodies and coordinates work relating to health issues that need to be addressed. The function of the Board has come under review owing to the need to clarify its accountability. The Board is a coordinating body for multisectoral investment in health and it coordinates all governmental activities that affect public health, including determining tax policy, defence and food policy, as well as defi ning sports and cultural programmes, introducing new technologies, road traffi c safety and the protection of health at work. However, it only has an advisory role, that is, it can only point to problems, but has no decision-making power.

The overall structure of the health system, the level of guaranteed health care benefits has improved significantly, along with health safety and security, the current health status of the population, organization of health care services, as well as method and sources of financing the health system and its management. It is therefore possible to conclude that the steps that have been taken in the past to reform the pre-1992 health system have been proven to be largely successful.
For example, the privatization of parts of health care services at the primary level is considered to be a measure that has contributed to improving effi ciency, as the private providers compete with each other and with the public system for contracts with the HIIS. Controversies remain, however, regarding the means of monitoring and adequately allocating fi nancial resources through these processes. However, only partial privatization of health care delivery took place, while reform of other aspects, on a larger scale, has not yet even been started at the time of writing. Privatization of primary care infrastructure and allowing more space to be allocated to private initiatives may become the key areas receiving more attention in health policy in the future. The Ministry of Health will seek ways to rationally approach the issue of privatization of primary health care, while simultaneously considering options for the privatization of hospitals, which will mainly apply to some of the smaller general hospitals. Some of these decisions will depend heavily on the priorities of the incoming government (November 2008), which is likely to be more reserved with respect to the privatization process. There still remain challenges to be resolved. Slovenia’s spending on health as share of GDP is as much as the EU average at the time of writing. The public proportion of health expenditure has been reduced over recent years, causing some concern over the sustainability of such an approach. Nevertheless, the main challenge for the future will be to improve the effi ciency of the health system. Evolution of medical technology and pharmaceutical innovations, increasing population expectations for new treatments and an ageing population require not only skilled human resources, appropriate premises and modern equipment, but also additional fi nancial resources. The discrepancy between the needs and demands of new technologies and resources for their funding is constantly growing. Therefore, a critical and continuous assessment of the introduction of new methods of medical treatment is required. New technologies should include impact assessments of the health status of the population, and effi ciency and effectiveness of the utilization of current and future investments in health care (Turk & Albreht 2008).
Moreover, the Slovene health care system is faced with a lack of physicians and certifi ed nurses, which is a relevant risk factor in implementing and maintaining quality in health care. Hence, the challenge for the future is to ensure continuous development of human resources. Education and training in the areas of quality and patient safety should become an integral part of the curricula of all health education institutions and programmes, as well as of internal education programmes in each health care organization, and requirements related to quality and patient safety should be included in the education and training of health care providers. Continuous development of individuals also needs to be ensured through acquisition of new knowledge in the areas of quality and patient safety, and development of social and personal skills and behaviours (such as doctor–patient communication).
Waiting lists for some health care services have  become a signifi cant political issue. An active approach to the resolution of this challenge has resulted in important improvements in waiting times for cataract, hernia and open heart surgery. Problem areas, such as hip and knee replacements, remain an important focus. More incentives for a move into outpatient and day surgery are needed. Very different data have arisen concerning effective waiting periods in various hospitals; a decision was therefore made to establish a national waiting list for a number of the most common conditions. A newly developed web-based solution provides information on waiting times for common diagnostic and therapeutic procedures. Due to the rapid ageing of the Slovene population the need for long-term care services outpaces their supply. This situation demands more funds and attention.The new proposal on long-term care defi nes services that assure social care and health care to individuals in need of long-term care. In the fi rst instance, home care services will be provided and subsequently, when this is no longer feasible, institutional long-term care will be offered. The associated fi nancial risks will be covered by a new, special long-term care insurance, which will be based on the same fi nancing principles as the other branches of social insurance. In the fi rst half of 2008, Slovenia held the EU Presidency. The Government decided to present cancer as the main public health topic, considering its increasing importance in terms of incidence and survival rates, the challenges it represents in terms of organization of health care, including delivery and financing, as well as the need for international collaboration and to ensure the basis for long-term care and sustainable and publicly funded research. After a period characterized by lack of commitment regarding this issue, both the political will and the professional determination to provide for a more stable and organized framework for cancer control have emerged at the time of writing.This is to be based on four pillars, as proposed by the Slovene EU Presidency:
primary prevention, screening, integrated care and research. For the latter, it is important that signifi cant resources are earmarked for the funding of the different EU initiatives, programmes and projects (Albreht 2008a). The Council of the European Union adopted binding conclusions on cancer issues, which will pave the way for the future adoption of an Action Plan on Cancer for the EU. The second health topic of the Presidency was alcohol control policies; a structured process was introduced, aiming to prepare an adequate framework for comprehensive control of alcohol consumption. This topic is especially important for the newer EU Member States.