|Implemented in this survey?|
The Ministry of Health decided to put an end to the open cream-skimming which started after more general insurance companies entered the voluntary health insurance market. Portfolios of these companies developed unevenly, beginning to threaten equity and protection of the vulnerable groups' interests. A change to the Health Care and Health Insurance Act now defines the introduction of risk equalising schemes. Adopted in August 2005 it will come into force in March 2006.
The main objective of this new concept is in equalising the risks citizens incur when opting for voluntary (co-payment) health insurance. In the last years, some insurers introduced ratios between the highest and the lowest age group of 1:10, clearly favoring the very young and putting the elderly into a disadvantaged position. Equalising schemes should reduce the burden of the biggest insurer for voluntary insurance that 'inherited' a lot of the insured elderly from a previously designed system. The legislation change speaks of the public interest for this type of insurance and defines the following principles:
The expected outcomes are:
Risk equalizing schemes are going to be introduced in Slovenia with all insurers for voluntary health insurance having the same right to access the market. As this market is regulated by the MoH, they will have to obtain its approval to enter. They have to accept all those who have standard compulsory health insurance. All insured have to pay the same premium, except for those companies whose administrative costs are lower, in such cases a discount of a maximum 3% can be granted. The only reason for premature cancelation of the contract can be failure to pay rates of premiums.
Equalization is performed based on the periodic calculations produced by the MoH and grounded in the averages calculated per age group and sex. It does not apply only in those cases where the difference incurred is lower than 1.5 % of the gross premiums increased by the commission obtained.
insured/citizens, voluntary insurance companies, Ministry of Health
|Medienpräsenz||sehr gering||sehr hoch|
This is not an original approach since it has been used in many other countries in similar and different situations. Overall, if implemented correctly, these changes could introduce important changes towards a more equitable system of voluntary health insurance. There are strong and high public expectations from these changes, although they are not clear enough to the average citizen.
For more than five years there has been a rather uniform opinion, irrespective of the political governmental setting, that risk equalising schemes should be introduced. A couple of years ago,
after the entry of a third insurer, a subsidiary of the biggest general insurance company in Slovenia, this subject became even more important. This last insurer launched an overt cream-skimming
campaign in which the premiums span was from 1 to 10. Furthermore, there were all sorts of gaming going on between the other two insurers. On the other hand, there was a certain monopoly created
through the largest company, having over 1.1 million insured.
While the previous government did not succeed in passing this legislation for controversial issues, these were overcome now and the political will was strong enough for the law to be passed without much delay. Nevertheless, it was a strong priority of the present government to arrange this important area as spending on voluntary health insurance had reached a total of 15% of all health care expenditure.
Political committment through a longer period to arrange risk equalizing schemes
Strategy of the Ministry of Health for 2005
|Implemented in this survey?|
The idea was more openly and clearly generated within the previous health care reform launched in 2003.
There were clear signs of disbalances between different insurers and lack of equity was raised at the same time as voluntary (co-payment) insurance with its flat rates actually contributed to the regression of the system.
When there were also signs of over competition for younger and healthier insured, it seemed obvious that this issue could not be left to pure competition between unequal providers of voluntary health insurance.
Last but not least, another critical issue was the fact that the biggest provider of voluntary health insurance had inherited a large number of retired senior insured (high risk patients) and could not hope to win in a competition with newer providers.
With the change of government, the topic was brought to the front of the agenda since it had been left behind with all the pending hot topics. In a matter of a few months the proposal was ready, prepared by the Ministry of Health. It was adopted at the beginning of August through a fast track procedure at the Parliament.
It is not an original policy process as it has been quite well established in several other countries. The main actors were the Ministry of Health, voluntary insurance companies and, also, the Consumers' association.
The approach of the idea is described as:
amended: Ammendment to the Health Care and Health Insurance Act from 1992 (see references)
There was an atmosphere of rather uniform support to the risk equalizing schemes concept, mostly due to the following issues:
The Ministry of Health was the main promotor and took leadership in the process, while both the insurance companies on the one hand, as well as patients and/or citizens on the other hand felt supportive of the process.
|voluntary health insurance providers||sehr unterstützend||stark dagegen|
|patients and citizens||sehr unterstützend||stark dagegen|
On 5 August 2005 the changes to the Health Care and Health Insurance Act were formally adopted by the national Parliament introducing a full-blown transition to the new system within a period
of six months during which the essential preparations should be done and proposals offered to the public.
Definitely there were different pressures involved in the decisionmaking and legislation process. The main idea was to still leave some room for a privileged position of one of the insurers, while on the other side there were ideas that too free a competition should be strictly controlled or even limited. Still, the MoH insisted with its proposal which was eventually adopted in a form which was not that different from the original proposal.
|voluntary health insurance providers||sehr groß||kein|
|patients and citizens||sehr groß||kein|
It is very likely that the policy objectives will be reached to a large extent. Still, the fight for the insured has not been finished with the adoption of the new act and its amendments. It remains to be seen after the transition period how many insured will change their voluntary health insurer and why and if this process will lead to any kind of important movements of insured at all. The system should become more equitable than today with less financial burden put on the shoulders of some vulnerable categories of the insured.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
Impact of this policy will need to be seen after a few years of implementation and evaluated through the outcomes in view of the objectives discussed above.
Health Care and Health Insurance Act. Official Gazette of the Republic of Slovenia 1992; 9:577-590.
Law on changes and ammendments to the Health Care and Health Insurance Act. Official Gazette of the Republic of Slovenia 2005; 76: 8157.
Strategy of the Ministry of Health for 2005. www.gov.si/mz