Podaljano bolninicno zdravljenje

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Re-orienting the Slovenian Ministry of Health
for more effective stewardship of the health
system
Dorjan Maruic, M.D., B.Sc. Deputy Minister of
Health Ministry of Health Slovenia
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Agenda

• Facts
• Health insurance fund
• Final messages

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Slovenia, tops EU newcomer list
AREA 20 000 sq km2 (0.5 of the total EU-25
area) POPULATION 2 000 000 (88 Slovenes) (0.5
of the EU-25 pop.) GDP PER CAPITA 12 080 (47
of the EU-15 average) UNEMPLOYMENT RATE 6
(EU-15 average 9) SOCIAL HEALTH INSURANCE
compulsory health insurance LIFE EXPECTANCY
73,2 (M), 80,7 (F) 38,6 YEARS MEDIAN AGE 14,9
gt 65 and 16 lt 14 years (EU 17 and 18) (2050
39 gt 60 years EU 35) NATURAL POPULATION
GROWTH -1,1 DISEASE BURDEN () 26
Neuropsychiatric disorders 17 Cardiovascular
diseases 16 Malignant neoplasm's CAUSES OF DEATH
() 41 Cardiovascular diseases 26 Malignant
neoplasm's 8 Injuries

Financial resorces 9,14 GDP (app. 1235 USD)
(8,9 GDP) PUBLIC Compulsory health insurance
6,7 GDP (73.1) (6,8GDP) 77 State and local
budgets 0,3 GDP (4,0) (0,3GDP) 1
PRIVATE Voluntary health insurance for
co-payments 1,2 GDP (13.3) (1GDP) 13 Direct
payments 0,9 GDP (9.5) (0,8GDP) 9 Per
capita All expenditures 750 US 1462 PPP
Public expenditure 661 US 1137 PPP
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Health Care System Legislation in 1992

• Structural changes
• in the health care financing mixed model
• compulsory health insurance
• voluntary health insurance
• investment funds
• The state in hospitals and clinics
• Self-governing communities in public health
  centers
• in the delivery of health care services
• process of the privatization public-private-mix
• choice of personal doctors
• Key subjects and their roles in the system
• partnership negotiation and contracting process
• management from macro to micro level

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The Mixed Model

• The Slovene health care system carries the
  characteristics of the contracting model and
  integrated health care system.
• Performed services are paid by the HIIS based on
  the contract between HIIS and the health care
  providers
• The employees in public health care institutions
  have the status of public employees. They are
  paid in accordance with a collective agreement.
• Most private providers are contracted by the HIIS
  and represent part of the public health care
  network.

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(No Transcript)
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The Role of the Ministry of Health

• Strategic planning
• Health policy development and implementation
• Policy, regulations and financial resources for
  tasks following legislation
• Planning and capital investment for secondary and
  tertiary health care facilities
• Capital investment planning for primary health
  care facilities was delegated to the
  self-governing communities
• the pace and extent to which the communities have
  taken up this task differs

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Agenda

• Facts
• Health insurance fund
• Final messages

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HIIS Legislation

• Law On Health Care And Health Insurance (1992)
• IV. Institute For Health Insurance Of Slovenia
  (HIIS)
• Article 69 77
• HIIS was created
• as a public and not-for-profit entity
• the only provider of compulsory health insurance
  to the population
• strictly supervised by the state and bound by
  statute
• statute is subject to approval by the MoH

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HIIS tasks and organization

• HIIS tasks include
• providing compulsory insurance
• concluding contracts with health care providers
  and suppliers of technical appliances
• supervisory and administrative tasks
• providing legal and other professional assistance
  to insured people
• maintaining a database and statistics on health
  insurance
• proposing contribution rates.
• HIIS organizational scheme
• 56 branch offices
• 10 at the regional and 46 at the local level
• Regional HIIS councils
• advisory role in relation to the central level
• no decision making rights concerning health
  insurance

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HIIS Organs of GovernanceAssembly, Management
Board, Director

• HIIS Assembly
• HIIS is governed by an assembly
• made up of elected and nominated representatives
  of employers, insurers and government
• Mandate of the management board
• HIIS yearly financial plan and financial report
• Legal documents, that define rights of insured
  persons
• Regulation CHI, list of medicines, standards of
  services
• Criteria's for health care financing
• Decisions about proposal for contribution rate
  for CHI
• HIIC director
• nominated by the assembly
• appointed with the agreement of the parliament

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Social health insurance schemeCompulsory
health insurance (CHI)

• Single provider Health Insurance Institute of
  Slovenia (HIIS)
• 98 of Slovenians entitled to CHI benefits
  (subject to co-payments 5-75)
• Two large fields of benefits
• health services at the primary, secondary and
  tertiary level
• cash benefits (in case of sick leaves, travel
  expenses )
• Gathered funds as contributions (solidarity
  principle)
• 391 billions of SIT or 1,63 billions of EUR 98,8
  income (2004 396 billions of SIT)
• Workers 13,45 bruto income 5050 shared
  between employer and employee
• 77,5 HIIS income
• Pensioners fixed amount (5,65)
• 16 HIIS income
• Self-employed fixed amount
• 0,3 HIIS income farmers
• Unemployed covered by The National Employment
  Institute
• Vulnerable and socially disadvantaged persons
  municipalities
• 5,0 HIIS income others
• Children and students nothing

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Social health insurance schemeCompulsory
health insurance (CHI)

• Cost-sharing in the system direct co-payments or
  voluntary HI
• Insurance for co-payments introduced in 1992
• In 1994 94 of Slovene citizens in VHI
• Single premiums for different insurance policies
  and age
• 13 of health expenditures are paid through the
  VHI (competition of 3 providers)
• 73 of health expenditures are paid through the
  CHI and covered by HIIS
• 406 billions of SIT or 1,69 billions of EUR HIIS
  expenditure (2004)
• 68,5 health services
• scope and value of the program of services are
  negotiated each year
• 18 drugs and MD
• 10,7 cash benefits
• 2,8 HIIS costs

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Funding Network In Slovenia
HEALTH SERVICE PROVISION
FUNDS
FUNDS MANAGEMENT
PUBLIC INSTI-TUTIONS
CONTRI-BUTIONS
HIIS
COMPUL.
PUBLIC NETWORK
CONCES-SIONAIRES
RESIDUAL
INSURANCE COMPANIES
PREMIUMS
PRIVATE NETWORK
DIRECT PAYMENT
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Agenda

• Facts
• Health insurance fund
• Final messages

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Levels of regulation

• The health sector is regulated at various levels
  and by several organizations
• The government (MoH and MoF) and the parliament
• set the limits of contribution rates
• set the limits of yearly CHI budget
• HIIS
• Preparation of the CHI annual financial plan
• HIIS assembly accept the CHI plan
• Health care partners (MoH, HIIS, providers,
  chambers)
• Program of health care services is managed
• by statutorily defined partners
• in the framework for the partnership negotiating
  process for each year
• coordinated and respected by the annual planning
  process of the HIIS

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Weaknesses and Dilemmas in the Health Insurance
System, Organization and Management

• Loss in CHI funds since 2000 accumulated to 123
  mio EUR (8,2)
• Supplementary insurance premiums too expensive
  for a portion of population
• Rather high absence from work due to sickness and
  injuries (4,56)
• Absence of competition in the provision of health
  care services
• Poor professional supervision
• Weaknesses in service provider reimbursement
  models
• Inadequate hospital management methods
• Minimum degree of privatization achieved
• Certain inconsistencies in the regulation of
  social rights
• Extensive drug consumption (7 prescriptions and
  16.5 packages per capita)

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Law On Health Care And Health Insurance changes
in 2006

• Key changes
• Assuring solidarity and fairness of financing
• Definition of individuals granted health care
  insurance covered by state budget
• 100 coverage by obligatory insurance for a group
  of socially deprived
• Shift from salary to income based contribution
• New relationships among partners
• Partnership negotiation every 2 years
• New roles and responsibilities of partners
• Stricter sanctions
• New structure of HIIS assembly

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Take home messages

• Evolution (change) is the natural state of all
  health care systems!
• An ideal health system is not possible to build
• In the process of building it, the demand for
  systems to produce quantity always seems to take
  priority over the irrational field of quality!
• Responsible and careful management of the
  well-being of the population is the essence of a
  good Government !

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Everybody makes mistakes!The stupid ones repeat
old mistakes the clever ones make new mistakes!
Thank you! dorjan.marusic_at_gov.si