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17 December 2021 | Country Update
Long-term Care Act adopted by Parliament in December 2021
6.2. Future developments
Much of the policy effort in the years to come will deal with the continued implementation of ongoing reforms. In addition, the COVID-19 pandemic has uncovered – or further highlighted – weaknesses in the health system, including workforce shortages, waiting times for secondary ambulatory services, ageing hospital facilities and a fragmented and underfunded LTC system. The following areas are expected to be priorities in the coming years.
Long-term care (LTC) reform in Slovenia has been on the policy agenda since the 2000s. Historically, LTC has been the joint, or rather, shifting responsibility of the Ministry of Health (MoH) and the Ministry of Labour, Family, Social Affairs, and Equal Opportunities and service provision and financing are fragmented. Recently, there have been several efforts to streamline LTC functions, including a new Directorate at MoH in 2016 to develop, coordinate and implement an overarching LTC Act, though this was ultimately downgraded to a Service. The need for universal systemic reform of LTC was underlined by the COVID-19 pandemic.
In December 2021, after some delay, the new Act on LTC was adopted by Parliament, and includes a framework for financing, service provision and training for new staff. The enactment of the new law in the nursing homes is expected from 1 January 2023 and the launch of the new financing scheme from 1 January 2024. With financing only slated to start in 2024, Slovenia’s LTC is currently in an intermediary situation with the system depending on financial resources of the past. With the Minister of Health being the vice-president of the biggest political party in Slovenia, LTC remains a priority, with another Service for Long Term Care established.
References
Homepage of the Government and the MoH of Slovenia: https://www.gov.si/en/state-authorities/ministries/ministry-of-health/
6.2.1. Primary health care
The view is to establish a HPC next to all CPHCs over the next three years. In addition, MHCs (see section 7.6.1), staffed with registered nurses, psychologists and psychiatrists, will be launched in 2021 to facilitate access to psychiatric and psychological care at the community level.
Further, reforms will focus on ways to increase primary health care professionals’ satisfaction and work experience and reduce burnout; address organizational and governance challenges constraining primary health care performance; establish an effective quality improvement system; and ensure sustainability of health care financing. Innovations may include strengthening the MoH’s institutional capacity to serve as an effective steward of the health system overall; replacing the current morass of administrative and clinical information systems with user friendly, fit-for-purpose information systems for outcome-focused quality improvement processes at both the facility and system level; reforming the ownership and governance structure of primary health care facilities; and strengthening the governance structure of the ZZZS.
Finally, the process of developing a primary health care strategy will continue. This will build on the 2016 draft strategy and include measures to address fundamental issues within the current system as identified by the WHO Regional Office for Europe in 2019.
6.2.2. Public health strategy
As mentioned above, the MoH, the NIJZ and the WHO Regional Office for Europe, together with national professionals, performed a self-assessment of Slovenia’s public health system across the WHO Regional Office for Europe’s 10 EPHOs in 2017–2019. The final report and recommendations will be applied in the development of a new national public health strategy. The strategy will aim to further strengthen public health capacities and services, both at the population and individual level, and enhance collaboration within primary health care. Specific priorities will include health equity; addressing upstream health determinants through multisectoral collaboration for health; and strengthening public health intelligence, particularly by introducing data modelling-based predictive analytics.
6.2.3. Long-term Care Act implementation
If the LTC Act is adopted by Parliament, then a major task of the Slovene health system will be to operationalize it in the years to come. As envisaged, the rights under the LTC Act will be integrated at intervals. For example, a full legislative proposal for a special bill on mandatory LTC insurance, which will determine the conditions – including financing – of compulsory insurance for LTC, is expected in 2024 and implemented in 2025.
6.2.4. Public health care facilities management and governance
Managers of the publicly owned health care facilities need more powers and tools for effective leadership and management, both in terms of financial and performance outcomes. Professional criteria for the members of health care institutions governing boards need to be introduced, defining the required knowledges, skills and experiences of the members.
Additional investments are expected to rebuild some of the older hospitals, digitalize the epidemiologic surveillance system and introduce an electronic-based system for the coding of causes of death.
6.2.5. Health digitalization
Although Slovenia does not yet have a digital health strategy, comprehensive upgrades to existing digital applications will likely be undertaken to ensure user friendly information systems that support quality improvement and managerial processes at both the facility and system level. Plans have already been included in Slovenia’s submission to the EU Recovery and Resilience Fund for 2021–2026.
6.2.6. Waiting times
As waiting times and lists continue to be a health system challenge, more efforts to address them are expected. Specifically, the MoH will introduce measures to improve the reporting accuracy and timeliness of provider self-reported data about waiting times/lists. Extra funding of services to shorten waiting times is envisioned, which will also be expanded to private providers.
6.2.7. Financial sustainability of health system and diversification of revenue sources
As envisioned in the National Health Care Plan (2016–2025), the Health Care and Health Insurance Act (1992) needs to be updated to: 1) adjust the basket of basic services covered by SHI and complementary VHI to support the financial sustainability of health care system and services; and 2) diversify health funding sources by increasing the share to health from the state budget and by broadening the eligibility base (and adjusting rates) for SHI contributions. Diversifying the system’s revenue base to ensure a stable and adequate level of funding for priority health programmes will help ensure that the policies and practices of the ZZZS support the achievement of the goals and objectives set out in the National Health Care Plan.
Also, complementary VHI contributions need to switch to a progressive scale. Moreover, the allocation of funds needs to be redefined: 1) to ensure more flexibility for their use; and 2) to clarify who can decide how they are going to be used (at the moment, the ZZZS defines their use to a certain extent but often not all funds are used). In doing so, this may help to offset the impact of economic crises on health financing. For example, during the 2008/2009 financial crisis, the payroll-share of SHI contributions was reduced. This loss of revenue could have been balanced by more flexibility in the use of complementary VHI.
6.2.8. Human resource management plan
Human resource shortages due to the lack of planning at national level based on the needs of population represent a serious challenge for the Slovenian health system. The COVID-19 pandemic has revealed further shortages of health professionals, in particular in public health and in primary health care. A process to prepare and adopt human resource management plan based on the needs of population has been started at the MoH recently. In August 2021, the MoH appointed a special committee for the preparation of a strategy for planning and forecasting of health workforce (nominations in progress at time of writing). The objective is to prepare a special strategy with a dynamic approach to adapting the needs for health workforce. The plan will also serve as a basis for planning investments in health care facilities and procurement and distribution of expensive technologies.