Despite good health outcomes, a PHC model characterized by multidisciplinary teamwork, strong links to public health and universal financial coverage for health services, Slovenia’s PHC faces myriad challenges.
Demographic and epidemiological transitions, technological advances, and adjustments to service delivery have changed patient expectations and increased the demand for (longer) clinical visits at PHC for more complex patients. Meanwhile, personnel challenges hamper the PHC system’s ability to meet population needs and ensure quality and safety of care.
There is a shortage of PHC physicians: around 120,000 adults are not registered with a PHC team due to lack of capacity. This shortage is getting worse due to an ageing PHC physician population (about 30% to retire in the next 5-10 years) and difficulty in attracting/ retaining physicians because of, e.g., dissatisfaction with salaries, working conditions, and inadequate professional development and support. Consequently, existing PHC physicians face high workloads but are still expected to increase the services they provide.
Meanwhile, there isa twofold spillover effect. First, those without a primary provider use emergency care, which both overburdens the emergency care—itself lacking adequate staffing levels—and raises healthcare costs. Second, saturated PHC teams refer patients to secondary ambulatory care for treatment that could be managed at PHC given more capacity. This generates long waiting times for non-urgent hospital ambulatory care services.
Between 2017 and 2022, Slovenia introduced several piecemeal financial interventions to immediate effect to address workforce challenges and other tenacious issues plaguing PHC.
Project to shorten waiting times in hospital ambulatory healthcare and improve medical service quality at primary level (2017; €36 million)
- Publicly employed PHC providers can be remunerated additionally based on performance up to 25% of base salaries in family medicine and primary pediatric practice
- Dedicated funds are provided from the national budget, not from the health insurance institute (HIIS)
- Requires use of the newly introduced eHealth services
Decision for special programs on PHC (2019; approx. €9 million provided from the national budget of the RS)
- Introduces a scale awarding certain percentages of additional remuneration for exceeding the 1,895-capitation quotient in family medicine and primary pediatric practice
- Extends office hours by minimum 1 hour to ensure enough time for patients
Special government project on family medicine and primary pediatric practice (2021)
- Introduces shift of funding from national budget to HIIS and fee-for-service purchasing for all services provided that exceed the monthly plan
Measures to ensure healthcare system resilience (2022)
- Supplements for healthcare employees at all levels introduced and financed from state budget, e.g., for increased workload, and for working in less-developed geographic areas and municipalities with a lower degree of economic development
Together the measures established a new precedent for increased funding of healthcare services from the state budget. Evaluations have yet to be performed, but anecdotally family physicians seem better satisfied with their incomes since implementation. However, PHC performance isn’t improved and over 100,000 patients are still not registered with a PHC physician. Thus, the impact on waiting times and emergency care persist. Additionally, interest for PHC jobs among young physicians has not improved either.