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Long-term care insurance - an idea revived?

Country: 
Slowenien
Partner Institute: 
Institute of Public Health of the Republic of Slovenia, Ljubljana
Survey no: 
(14) 2009
Author(s): 
Tit Albreht
Health Policy Issues: 
Rolle Privatwirtschaft, Pflege, Organisation/Integration des Systems, Finanzierung, Leistungskatalog, Zugang, Patientenbelange
Reform formerly reported in: 
Act on insurance for long-term care
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein nein ja nein nein nein

Abstract

Long-term care is a long-standing problem in Slovenia. Currently, funding is split between the social care sector, pension insurance and compulsory health insurance. Demographic changes caused a sharp increase in persons needing assistance, which represents a burden both for the public sources of funding as well as for the families. In 2006 a draft law on long-term insurance was ready for submission to the government but then withdrawn due to lack of consensus - currently the debate goes on.

Neue Entwicklungen

Economic and financial crisis coupled with the quickly developing demographic changes is triggering the need for immediate responses to the most important challenges, also in the social and health sectors. What was previously known about the continued ageing of the Slovenian population will soon develop into a serious challenge for the society. This fact has certainly contributed to the raised awareness of this topic and to its return to the policy agenda. The original idea has been updated with comments, proposals and amendments from the previous public discussion (in 2006/7) (see HPM 9/2007, "Act on insurance for long-term care").

The most important policy change since the proposal of 2006 is that the new proposal, announced publicly by the minister, will now be co-ordinated and submitted by the Ministry of Labour, Family and Social Affairs (MLFSA). The previous proposal was prepared and then submitted for preliminary discussion by the Ministry of Health. As the MLFSA is financially stronger and has a direct interest in relieving the burden on the social sector because of long-term care, it is expected to be a strong actor in the process of its adoption.

 Suchhilfe

Characteristics of this policy

Innovationsgrad traditionell neutral innovativ
Kontroversität unumstritten kaum umstritten kontrovers
Strukturelle Wirkung marginal recht fundamental fundamental
Medienpräsenz sehr gering recht hoch sehr hoch
Übertragbarkeit sehr systemabhängig recht systemneutral systemneutral
current current   previous previous

The current ratings are based on the conceptual framework of the previous proposal and on the announced basic outline of the forthcoming one. In the next report, we will be able to report in greater detail.

Purpose and process analysis

Current Process Stages

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

Initiators of idea/main actors

  • Regierung: Change of leading ministry from the health to labour, family and social affairs
  • Leistungserbringer

Stakeholder positions

The Ministry of Health in the previous term of the government was unable to achieve consensus around the proposal that they had prepared with the assistance of the participating key stakeholders. With the change of government this topic again achieved considerable policy attention. The main move is in the co-ordination role in the preparation of this law moving to the Ministry of Labour, Family and Social Affairs. The main ideas and approaches remain the same. It remains to be seen whether there will be a continuation of the same outlines proposed in the early texts or if there are going to be some additional solutions proposed.

 

Actors and positions

Description of actors and their positions
Regierung
Ministry of Healthsehr unterstützendsehr unterstützend stark dagegen
Ministry of Financesehr unterstützendunterstützend stark dagegen
Health Insurance Institute of Sloveniasehr unterstützendsehr unterstützend stark dagegen
Leistungserbringer
Nursing Chamber of Sloveniasehr unterstützendunterstützend stark dagegen
Association of Social and Nursing Homes of Sloveniasehr unterstützendunterstützend stark dagegen
current current   previous previous

Influences in policy making and legislation

The main development in the preparation of a new law on long-term care insurance is that it moved from the Ministry of Health to the Ministry fo Social Affairs, which means that it may gain in political weight due to the greater influence the the MLFSA has inside the government.

Particular details of the proposal have not yet been revealed. It is expected that the total payroll contribution for this insurance will be 0.5%. There should be the same employer and employee split as with the health insurance. The similarity with the present arrangements in pension insurance would be in the establishment of a second pillar for long-term care insurance, which would act as a private fund with own acquired rights related to the contributions paid. The main uncertainty that needs to be clarified is to what extent this will influence present contributions for health insurance. Should they remain unchanged, this insurance will represent an additional burden on the payrolls.

Actors and influence

Description of actors and their influence

Regierung
Ministry of Healthsehr großsehr groß kein
Ministry of Financesehr großsehr groß kein
Health Insurance Institute of Sloveniasehr großsehr groß kein
Leistungserbringer
Nursing Chamber of Sloveniasehr großneutral kein
Association of Social and Nursing Homes of Sloveniasehr großgroß kein
current current   previous previous
Ministry of Health, Health Insurance Institute of SloveniaNursing Chamber of SloveniaAssociation of Social and Nursing Homes of SloveniaMinistry of Finance

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

 

Monitoring and evaluation

 

Expected outcome

It is expected that this proposal will revive the debate on the need for a long overdue legal regulation of this important area of social care and insurance. As this debate has been lingering on for more than a decade and the problem of long-term care for an ageing population has grown to significant proportions, the present proposal should provide a solid ground for a broader public debate. The positive incentive is definitely the present economic and financial crisis, which will strengthen the political side - the proposers of the new law. The negative impact will be in the lack of readiness for the debate both on the side of the employers as well as the employees.

Impact of this policy

Qualität kaum Einfluss neutral starker Einfluss
Gerechtigkeit System weniger gerecht four System gerechter
Kosteneffizienz sehr gering neutral sehr hoch
current current   previous previous

The current ratings are based on the conceptual framework of the previous proposal and on the announced basic outline of the forthcoming one. In the next report, we will be able to report in greater detail.

References

Sources of Information

  1. Draft proposal of the Law on Long-term Care Insurance, Ministry of Health of the Republic of Slovenia, 2006.
  2. Public announcement of the Ministry of Labour, Family and Social Affairs on 29 September 2009 about the future launch of a new proposal of the Law on Long-term Care Insurance.
  3. Health Care and Health Insurance Act. Official Gazette of the Republic of Slovenia 9/1992.

Reform formerly reported in

Act on insurance for long-term care
Process Stages: Gesetzgebung

Author/s and/or contributors to this survey

Tit Albreht

 

Empfohlene Zitierweise für diesen Online-Artikel:

Albreht, Tit. "Long-term care insurance - an idea revived?". Health Policy Monitor, October 2009. Available at http://www.hpm.org/survey/si/a14/2