A central health policy of more than two decades was addressed this summer with the adoption of amendments to the Health Care and Health Insurance Act on 6 July 2023, which abolished the complementary health insurance (CoHI).
CoHI had been contested for various reasons by a large part of the political spectrum; however, many on the right and several experts remained unconvinced, stating that the CoHI was an important source of stable additional financing of health services. CoHI indeed bridged the gap in funding of compulsory health insurance during the austerity measures due to the financial crisis of 2009–2014.
The government has now decided to introduce a fixed compulsory contribution – currently €35 a month – that will be raised on all incomes by the Financial Administration (that is, IRS), starting 1 January 2024. The mechanism of potential future increases in this contribution seems more complicated than for the previous CoHI, and consequently, the Ministry of Finance will cover for potential “losses” on this insurance up to a total amount of €240 million. This limit was set according to EU regulations on containing public deficits.
What will happen with the insurance companies?
There are three CoHI companies. In real terms, only one, Vzajemna, is independent and covers almost exclusively CoHI. The others are subsidiaries or departments of larger insurance companies and represent one of the several items in their portfolios, including different types of supplementary insurances, mostly for queue skipping in outpatient specialist services and diagnostics. Vzajemna now faces a restructuring into a limited company. It is expected that the capital will be turned into shares and all the insured as well as the Health Insurance Institute of Slovenia, the single purchaser of public services, which has some funds invested, will become shareholders.
Challenges and issues?
One main concern about this new proposal is a gap in the offer of health services in the public sector, which is insufficient to meet the demand. This is coupled with poor incentives for (salaried) health professionals in the public sector, leading many to work either extra time or full-time with providers that mostly provide their services to the insured of the supplementary health insurance schemes. Further enhancement of these schemes could potentially challenge the equity of access, both in physical and economic terms.