Resolution-the national health care plan 2008-2013

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

Abstract

In contrast with the former planning processes in health care, Slovenia remained without a valid health plan since 2004. The lack of direction, strategical guidance and consistency in the decision making process resulted in several shortcomings. Most notable would be lack of strategy for the expenditure side of health care consumption, no uniform policy on health workforce planning and no clear-cut policy on approaching the challenges posed by privatisation in health care and demographic change.

Purpose of health policy or idea

The preparation of the Resolution for the national health care plan arose from the need for a strategic document in health care to be adopted, regardless of the close end of this government's term.

The main objectives were:

1. Bring the planning process in the Slovenian health care in line with the EU strategy on health.
2. Define the financial framework for (public) health expenditures the next six years.
3. Describe the present public health challenges and identify the key areas of action in the prevention of the most important chronic non-communicable diseases.
4. Propose an outline for the re-organisation of the public health infrastructure.
5. Define the national criteria for the allocation of human resources on ground for primary and secondary care as means of managing the network of health care providers.
6. Continued efforts to contain pharmaceutical expenditures.
7. Development of IT infrastructure in the Slovenian health care.
8. Ensuring that all national investments proceed according to plan and that they are finalised as designed.
9. Reinforcing the work on quality assurance in health care through mechanisms provided both by the scientific community as well as through processes managed by the Ministry of Health. 

 

Main points

Main objectives

The proposed Resolution is a strategic and planning document, which is supposed to provide guidance for the development of health care delivery in Slovenia over the period of the next six years. It provides the following elements:

1. The elements of the financial framework, which will determine the health care expenditure over the next period.
2. Describes the main public health problems and challenges to be addressed through a comprehensive approach based on the public health methodologies.
3. Determines the pace of the development of primary health care in the next period and confirms the present structure of health care delivery at the secondary level of health care.
4. Identifies the need to develop IT infrastructure in health care in order to support better care and help in better managing the process of patient care.
5. Reaffirms the EU strategical principles in health care and presents a set of ethical guiding principles for the national level.
6. Ensure the sustainability of the predominantly publicly financed heatlh care which remains of special value for the population of Slovenia.
7. Improve the management of all aspects of patient care.
8. Ensure the prompt finalisation of the existing national investments in health care and secure an easy transfer of the key tasks over to the regional level.

Groups affected

General population and (chronic) patients, Health care providers, Health professionals and their associations

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

Political and economic background

The most important factor that determined the pace of the preparation of the proposed Resolution was the need to adopt a national health plan, incorporating the national strategy for health and health care. The process under the previous minister for health, dr Brucan, was very lengthy and it did not yield positive outcomes. Furthermore, the proposal of a draft national health plan had been rejected after an open public debate. Soon after that, the minister resigned.

The incoming minister, Mrs Mazej-Kukovic took up the task to prepare a national health plan quickly and seriously. In view of the several hot topics, such as investments in public hospitals, she was unable to launch specific activities on the preparation of the plan before Christmas 2007. Then it was decided that the new health plan would be given the highest priority in the present government. The main principle was in implementing the EU principles and in defining some of the outstanding tasks in the strategy and planning of the national health care system.

Complies with

Change of minister and the need to have the national health plan ready for adoption.

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 strategy or indeed the resolution was started after the failure of the previous national health plan and strategy. The main idea of the resolution was to make an outline for the national health strategy, define the principles of the future development of health care in Slovenia and to list the priority area in the domains of: health care delivery, health information systems, quality assurance in health care, etc.

The main driving force was the minister, Mrs Zofija Mazej Kukovic, who decided to push strongly for the national health plan to be adopted during her short term (1 year) in office. The approach to the preparation of the document was completely new , but some aspects were borrowed from earlier discussions. There was much less stress on privatisation than in the previous document.

Initiators of idea/main actors

• Regierung

• Leistungserbringer

• Kostenträger

• Politische Parteien

Approach of idea

The approach of the idea is described as:
renewed: It was first voiced in 2005 when the previous minister started the work on a new health plan.

Stakeholder positions

There was a lot of criticism directed at the Ministry of Health (MoH), as the process of the public debate took a very short time at first and it was found necessary that more substantial evidence needs to be presented in view of the statements and decisions that were to be taken by the MoH with respect to health workforce planning, distribution and organisation of health care.

New Minister taking the lead

The leadership stayed with the MoH, while there was strong opposition by the Health Insurance Institute (HIIS). The minister herself felt very assertive in this matter and she managed to minimise the existing porter.

Actors and positions

Regierung
Ministry of Health	sehr unterstützend		stark dagegen
Leistungserbringer
Public providers	sehr unterstützend		stark dagegen
Private physicians	sehr unterstützend		stark dagegen
Kostenträger
Health Insurance Institute	sehr unterstützend		stark dagegen
Mutual insurance companies	sehr unterstützend		stark dagegen
Politische Parteien
Coalition	sehr unterstützend		stark dagegen
Opposition	sehr unterstützend		stark dagegen

Actors and influence

Regierung
Ministry of Health	sehr groß		kein
Leistungserbringer
Public providers	sehr groß		kein
Private physicians	sehr groß		kein
Kostenträger
Health Insurance Institute	sehr groß		kein
Mutual insurance companies	sehr groß		kein
Politische Parteien
Coalition	sehr groß		kein
Opposition	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

The document will now enter into open parliamentary debate, which means that disputes over some aspects of the plan will remain high on the agenda. This applies in the first place on the following topics:

1. Privatisation of health care delivery
2. Definition of criteria for distribution on ground (especially in primary care) 
3. Use of public resources of health care funding and sustainability of the present health financing schemes

Expected outcome

Impact of this policy

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

References

Sources of Information

1. Resolution of the National Health Plan 2008-2013 - in open discussion/governmental procedure
2. Working programme of the Slovenian government for the years 2004-2008

Author/s and/or contributors to this survey

Albreht, Tit

Empfohlene Zitierweise für diesen Online-Artikel:

Albreht, Tit. "Resolution-the national health care plan 2008-2013". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/si/a11/3