One year after elections: Change or continuity?

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

In October 2004, the newly elected center-right government announced new or changed reforms in health care. While the health care reforms of previous governments will be partly carried on, the overall environment will be more favourable for private provision and for market-oriented reforms in both economics and social affairs.

Purpose of health policy or idea

Several policy documents announce the changes: a more favourable environment for private provision of care, instituting the concept of 'free specialist', introduction of the right to be excluded from co-payments on social status grounds, restructuring of the private insurance market, incentives for more efficient and effective health care. The reform will be marked by the initial changes of the basic health care legislation dating from 1992 and later, by a process of continued changes in financing and organisation of health care.

Main points

Main objectives

Some of the main objectives of the health policy changes are summarized in the Program of the Government of Slovenia for 2005:

1. changes of the existing legislation
2. increased efficiency of the health care system
3. e-health
4. redefining the relationship between the state and private delivery of health care
5. quality in health care
6. project of the emergency medical care
7. management in health care (investments in knowledge)
8. affirming a health life style and reduction of differences in health
9. ensuring the conditions for  a quality controlled and active screening of breast cancer with consequent reduction of mortality due to breast cancer in women
10. purchase and substitution of worn-out expensive diagnostic equipment.

Groups affected

low income groups, all earning not salaried incomes - financial, real-estate etc., health insurance providers - mandatory and voluntary, injured in non-work related accidents and injuries

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

There are three main areas of intervention for the present government:

1. Ensuring rights of patients under a redefined insurance scheme and patient involvement
2. Organisation and health care delivery, by
   a) enhancing private entrepreneurship and a more flexible approach to private delivery of health care
   b) defining standards (numerical and geographical) for an equitable distribution and access to primary care
3. Investment in health care

The changes are based on a redefined mandatory health insurance basket of rights, reducing certain rights related to sickness leave financial benefits (lowering percentages of reimbursement for salaries during absence for injury-related conditions), introduction of a lower margin of income as the base for transfer of such insurees into mandatory health insurance instead of voluntary health insurance schemes.

Change of government

A significant change of government with introduction of a more liberal approach to organisation, delivery and financing of health care.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The main reason and the essential shift in the plans for reforming health care lies in the new government formed at the end of 2004, following a changed structure of the political arena.

The former opposition parties (Slovene Democratic Party - SDS and Nova Slovenija - NSi) obtained the biggest number of votes, forming a coalition with two smaller political parties - Slovene People's Party - SLS and the Democratic Pensioners' Party - DeSUS. Despite the fact that the latter two parties formed the outgoing coalition, it is an important change of government.

Health care is dealt within the coalition contract signed at the end of November 2004 and includes the topics discussed under the previous heading.

Approach of idea

The approach of the idea is described as:
renewed: Some of the concepts were in debate at the time of introduction of the existing health care and health insurance legislation. Later some of those (like liberalisation, opening the door to private provision and delivery of health care) were abandonned.

Stakeholder positions

Financial incentives:

1. continued process of introduction of a DRG-system of reimbursement in hospital in-patient care and preparations for its introduction into out-patient care
2. introduction of balance schemes in order to regulate better the voluntary insurance market and prevent cream-skimming
3. exclusion of the poorest part of the population from co-payment/voluntary insurance schemes and their inclusion in the basic  mandatory health care insurance
4. reduction of absenteeism through a lower level of rights for certain categories of absenteeism (injuries out of work, risky sports,  consequences of traffic accidents)
5. increasing the discipline in paying the mandatory health insurance premiums
6. inclusion of other sources of income as the base for health insurance
7. financial relief to the mandatory health insurance
8. redefinition of public investment in publicly-owned health care facilities
9. fairer system of salaries and incentives for better productivity on individual and collective level.

Non-financial incentives:

1. Increasing management skills in public institutions/health care providers
2. promotion of healthy life styles and responsibility for own health
3. establishment of an efficient long-term care legislation
4. establishment of the office of ombudsman for patients rights
5. redefinition and regulation of the relationship between publicly/state organised health care provision and private provision of health care
6. adoption of a patient code of rights and definition of complaints procedures
7. distinction in financing of secondary and tertiary health care.

Expected outcome

There are clear indications of developments towards a more liberal and market-oriented reform of the economical space as well as the social services. The private sector will be gaining more space but at the same time more supervision, quality assurance and supervision is to be introduced.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

References

Author/s and/or contributors to this survey

Tit Albreht, IVZ

Empfohlene Zitierweise für diesen Online-Artikel:

Tit Albreht, IVZ. "One year after elections: Change or continuity?". Health Policy Monitor, 15 May 2005. Available at http://www.hpm.org/survey/si/a5/4