Slovenia: health system review

Abstract

The Health Systems in Transition (‎‎‎HiT)‎‎‎ profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Life expectancy in Slovenia has improved since 1993, reaching 78.5 years in 2007. This value is comparable to those of other European Union (‎‎‎EU)‎‎‎ Member States (‎‎‎those belonging to the EU prior to 2004, plus those joining the EU on 1 May 2004 (‎‎‎EU25)‎‎‎)‎‎‎, but slightly below the average of the EU Member States before the enlargement of May 2004 (‎‎‎EU15)‎‎‎ and significantly above the respective average value of the countries that joined the EU in May 2004 and January 2007 (‎‎‎EU12)‎‎‎. Health care services in Slovenia are financed mainly by contributions to compulsory health insurance, premiums for voluntary health insurance (‎‎‎VHI)‎‎‎ and through taxes. Although entitlement to health care services is universal in Slovenia, access to some health care services is limited due to lack of providers (‎‎‎for example, dental care)‎‎‎ or long waiting times (‎‎‎for example, for certain operations)‎‎‎. Health care services at the primary level are provided mainly by state-owned primary health care institutions as well as by independent general practitioners (‎‎‎GPs)‎‎‎. Providers of primary health care act as gatekeepers for specialist services. Slovenia’s health care system has undergone major changes since the country achieved independence in 1991. This momentum of constant change was retained during the period from 2002 to 2007 and was based on a white paper published by the Ministry of Health and on the World Bank project “A Management Model or Health Care”. Reform policy during this period included, inter alia, reform of health care financing (‎‎‎for example, payment for hospital services is now based on diagnosis-related groups (‎‎‎DRGs)‎‎‎)‎‎‎; introduction of clinical guidelines by the Ministry of Health to increase quality of health care; cancellation of compulsory insurance (‎‎‎Health Insurance Institute of Slovenia (‎‎‎HIIS)‎‎‎)‎‎‎ debts; and subsequent introduction of a convergence programme to limit HIIS expenditure. Furthermore, a risk-equalization scheme for VHI was introduced in 2005, which aims to reduce cream-skimming between voluntary health insurers and to equalize the variations in risk structure between private health insurance companies.