Responsible BodyPolicy OverviewMilestones International CooperationMain DocumentsBasic IndicatorsContact PersonsUseful LinksResponsible Body Ministry of Health (Ministrstvo za zdravje) Štefanova ulica 5 SI-1000 Ljubljana, Slovenia Phone: +386 1 478 60 01 Fax: +386 1 478 60 58 E-mail: gp.mz@gov.si Web Page: http://www.mz.gov.si/index.php?id=670&L=1 Organization Chart Policy OverviewThe Slovenian health care system is based on the Bismarck-type of social health insurance and provides universal and comprehensive health care access to all Slovene citizens regardless of their income. In 2002, 8.3% of GDP was spent on health care, of this 74.9% came out of public sources. The rest came from the two main sources, the first and foremost, was voluntary health insurance, which in Slovenia's case is an insurance against co-payment and the second is out-of-pocket payments.The main organizational features of the Slovenian health care system, the key actors and their relationships are derived from the historical development of the system and are further based on legislation introduced in 1992, the Health Care and Health Insurance Act and the Medical Services Act. The Health Care and Health Insurance Act laid the basis for the present system of compulsory and voluntary health insurance, permitted privatization of health care, transferred some administrative functions to the professional chambers and established the basis for ongoing policy setting, strategic planning as well as development and implementation of disease prevention and health promotion programmes. Among the main actors in Slovenian health care system are the Ministry of health, The Health Insurance Institute, The national Public health institute and professional organizations. There is but one insurer for compulsory health insurer, the Health Insurance Institute of Slovenia whose roles and position were defined by the Act. The tasks of the Ministry of Health are to prepare legislation for health care and health protection and to ensure regulation and supervision of the implementation of legislation. The activities of the Ministry relate to health care at the primary, secondary and tertiary levels, including planning of public health care and the financing thereof. The Ministry furthermore monitors public health, prepares and implements health promotion programmes and ensures the conditions for people’s health education. Activities further focus on supervising the production, trade and supply of medicines and medicinal products and the manufacture, trade in illicit drugs. The Ministry is in charge of implementing international agreements on social security and of developing national health policies related to health care financing, health insurance benefits, quality assurance and planning of public health care facilities. The Ministry is responsible for establishing hospitals and public health facilities at the national level. The Ministry has four offices, the Health Inspectorate, the Office for Medicinal Products, the National Chemicals Agency, the Slovenian Radiation Protection Administration (SRPA) and an expert counselling body, the Health Council. The Health Insurance Institute of Slovenia, a public and not-for-profit entity supervised by the state, provides compulsory health insurance to the population. Voluntary health insurance, provided by a mutual insurance company Vzajemna and some private insurance companies, was introduced in 1993 to cover co-payments and to provide supplementary insurance. The Institute of Public Health of the Republic of Slovenia with the nine regional public health institutes covers the fields of social medicine, hygiene, environmental health, epidemiology, health statistics and research activities. The most important activities of the national Public health Institute are to implement the national programme of prevention, to collect and analyse data on the health of the population and health care services and, based on reliable data, to prepare health policy documents and suggest measures to improve and protect health.The health care delivery system is defined by the Medical Services Act. A GP gatekeeper system is in force which means that all referrals under the compulsory insurance are done by GPs. Some specialists are available at primary level and do not need referral, primary care paediatricians and primary care gynaecology services. GPs are reimbursed in half through capitation with 1850 persons per GP listed and the other half through fees-for-services delivered, half out of which need to be preventative. At the secondary level psychiatric services and services for venereal diseases do not require a referral. There are in total 26 hospitals, 12 of which are general hospitals, others are specialist hospitals, e.g. psychiatric, gynaecological, pulmology, etc. Hospitals are budgeted. The payment is based on number of cases and since 2004 there is variable part based on DRGs. The tertiary level includes university hospitals and institutes, performing highly specialized services, education, research, transfer of knowledge and development. In terms of delivery of services, there are public and private providers of health care services and both are reimbursed under the same principles. Most of the private practitioners work under concession on contract with the Health Insurance Institute of Slovenia. The only exception is dental services for adults where almost 15% work without concession and their patients pay for services in cash. The public health facilities at the secondary and tertiary level are owned ad administered by the State. Local governments of self-governing communities are responsible for planning, establishing and managing primary health care facilities, which is in part reflected in their responsibility for capital investment in public primary health care facilities and pharmacies. Main priorities The main priorities of the ministry are:to strengthen and further develop the social values such as solidarity, social justice and universal access to health rights and to pay special attention to socially vulnerable groups of population;to overcome the deficiencies in healthcare system such as increasing health care demand due to aging population, waiting lists, differences in access and quality of health care, diminishing health care income due to compulsory insurance contributions being bypassed, and lack of coordination between primary and hospital care, by further developing healthcare in gradual reform processes comparable to those in other European countries;to reduce the structural deficit in the healthcare fund and improve financial solvency, to introduce quality in healthcare and better efficiency of management as well as to better regulate the relation between the state and private sector in the public healthcare system;to proceed further develop the initiated payment model for services according to diagnostics-related groups;to launch a new national health programme until 2012 in which conditions, activities and measures for maintaining the health of citizens will be designed.Milestones turn of the 15th century Dr. Sanctorio Sanctori, a representative of late humanism in Slovenia, and a native of Koper, worked in Italy and introduced precise measurement - chiefly of body temperature - into medicine, and in his research on the digestive system he was also a forerunner of modern physiology. 1490 A milestone in Slovenian scientific history was the discovery of mercury in Idrija. Idrija became the second biggest mine of this metal in the world, after Almaden in Spain. The subsequent 500-year extraction of mercury in Idrija was a powerful stimulus to the development of science, medicine and technology in Slovenia and in the greater European continent. First half of the 16th century A famous physician and alchemist Paracelsus visited Idrija. He became the first to use mercury systematically as a medicine. First half of the 18th century Franc Anton Steinberg scientifically described the operation of the Idrija mercury mine. Second half of the 18th century Johann Anton Scopoli, a well-known physician from the Tyrol, and Balthazar Hacquet, a physician and natural scientist from Brittany, worked near the mine. Both of them described the mine in Idrija and its geological, technological and eco- logical properties in their works and passed on the knowledge of the particularities of Slovenia to Europe. 1887 Pension and disability insurance, the beginnings of which were connected to workers' funds, was first put into force within Austro-Hungarian imperium. The roots of the social security system on the territory of Slovenia thus show tradition of compulsory health insurance of more than 115 years. 1992 The Republic of Slovenia as an independent state adopted its own legislation in the field of health and social care and pension and disability insurance. 1992 1992 1992 The Health Care and Health Insurance Act along with the Pension and Disability Insurance Act were adopted in the same year and later implemented. The Health Care and Health Insurance Act along with the Pension and Disability Insurance Act were adopted in the same year and later implemented. Slovenia successfully joined both the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF). International Cooperation BILATERAL COOPERATION Slovenia has concluded several bilateral agreements on co-operation in the field of health and medicine, with a view to foster the exchange of information on several issues as the regulation of the health care and health insurance, the organization of health care activities, education and training of health proffessionals, health prevention and promotion. The agreements encourage also the exchange of experts for purpose of study and consultations as well as cooperation and common work on health related projects. Such agreements have been concluded up to now with Czech Republic, Slovak Republic, Albania, Israel, Kuwait, PR China, Russian Federation, Romania and Serbia and Montenegro, while several new agreements are envisaged to be concluded in the current year or in the year to come.Ministry of Health has developed so far an intensive bilateral cooperation on the regional level, whether through the bilateral agreements, concluded between Slovenia and some European regions, or on the basis of the common work on projects. Thus the cooperation with Flanders, Wallonia, Bavaria, as well as cooperation within Alps-Adria Community and Interreg has been initiated or carried out. MULTILATERAL - REGIONAL COOPERATION Stability Pact for SEE Health as a determining factor of social cohesion was included among the fields of activity of the Stability Pact for South Eastern Europe as early as in 2000. The year 2001 saw the adoption of the Action Plan of the Social Cohesion Initiative. In December of the same year, health ministers of South Eastern European countries signed the Dubrovnik Pledge on Meeting the Needs of Vulnerable Populations in South Eastern Europe, which represents a political consensus of South Eastern European countries on partnership cooperation in the field of health and on the provision of health services to vulnerable groups in the population of the region. In 2001, seven recipient countries of assistance from the Stability Pact for South Eastern Europe established the South Eastern European Health Network, which was joined in the following year by Moldova and three neighbouring donor countries: Greece, Hungary and Slovenia. The South Eastern European Health Network supported by Council of Europe and the World Health Organisation's Regional Office for Europe, is an initiative whose aim is to promote and implement joint activities of recipient countries and donor-partner countries in projects in the spheres which are in their common interest, as well as to coordinate and evaluate the implementation of the aims set in the Dubrovnik Pledge.Being aware of the importance of social cohesion for economic and general development, and for stability in the region of South Eastern Europe, the Republic of Slovenia decided in 2002 to join the group of donor countries that supports the implementation of the projects by providing technical expertise and financial assistance. To date, seven project proposals have been put forward, of which six are actually being carried out, i.e. projects in the fields of mental health, safety of foodstuffs, communicable diseases, blood safety, tobacco control and emergency health services.The Republic of Slovenia is determined to continue providing support for the activities of the South Eastern European Health Network, subject to the available scope of its expert knowledge and funds, and thus to contribute to a faster and successful development of the South Eastern European countries in the field of health, health systems and medicine.The Alps-Adriatic Working Community The Ministry participates in the activities and projects of the Commission IV for Health and Social Welfare with the priority of promoting the implementation of International ICF Classification in the Alps-Adriatic region and develop common language on disability. UNITED NATIONS ORGANISATIONS AND SPECIALISED AGENCIESWorld Health Organization - WHOSlovenia became a member of the WHO in 1993. Since than, many projects, programs and strategies have been successfully developed and implemented in Slovenia in co-operation with WHO EURO (Healthy cities network, Health schools network, Food and nutrition action plan, Health impact assessment of agriculture policy, etc). Four WHO collaborative centres operate in Slovenia, covering areas of mental health of children, arbo-viruses and hemorrhagic fever, nursing and reproductive health. In the last few years the main topic of cooperation was the reforming of health care. The main priorities of cooperation with WHO EURO in 2004/2005are:1. Health system infrastructure development, including:building consensus on developing the organization and financing of primary health care, carrying out policy analysis of needs and gaps for aftercare development, drafting policy for after care, developing a strategy for the development of primary health care in the next ten years. 2. Quality in health care, including:carrying out a policy analysis of needs and gaps for quality improvement, distributing and using a training package for generic quality standards and indicators, preparing a training package for hospital managers on introducing generic quality standards and indicators and 3. Investment for health - linking the development of most disadvantaged region in Slovenia, Pomurje, with health.In co-operation with WHO Slovenia is performing as a donor in the Stability Pact for SEE Countries. Slovenia is among those members of WHO that have already ratified the Framework Convention on Tobacco Control. UNESCO AND OTHER UN ORGANISATIONS AND SPECIALISED AGENCIES The Ministry of Health participates in the activities of the Division of Ethics of Science and Technology of the UNESCO. The Ministry cooperates with the Ministry of Labour, Family and Social affairs in reporting about the implementation of ratified conventions of United Nations Organisation and United Nations Specialised Agencies, especially the International Labour Organisation.The Ministry of Health implements also resolutions, adopted by the United Nations Commission on Human Rights, which cover the field of health protection. OTHER INTERNATIONAL ORGANISATIONSCOUNCIL OF EUROPE Health, ethics and human rights “When we speak about human rights, we rarely think about people being treated in hospitals and clinics, visited by doctors and nurses, or resting in homes for senior citizens. Yet, the ever-evolving concept of human rights and our understanding of it have been constantly enlarging their scope over recent decades. Through this evolution in our thinking and vision, we have come to realise that the right to good health and its protection is as much a human right as other commonly recognised rights and freedoms,” said Ms Maud de Boer-Buquicchio, the Deputy Secretary General when the European Health Committee celebrated its 50th anniversary in 2004.The Ministry of Health actively participates in the intergovernmental activities of the European Health Committee and the Steering Committee on Bioethics and joins international efforts to promote and implement the concept of human rights and health globally and nationally. Main activities of the European Health Committee are related to equity in access to health care and health promotion, patient’s rights and citizen participation and availability of and access to safe and good quality health care services. Slovenia has signed and ratified the European Agreements related to the healthcare field and the Convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine: Convention on human rights and biomedicine with Additional protocols. The Ministry of Health is responsible for the implementation. The Ministry participates in the activities of the Partial Agreements: Partial Agreement in the Social and Public Health Field, in the activities related to the Convention on the Elaboration of a European Pharmacopoeia, The Pompidou Group.It cooperates also with the Parliamentary Assembly on certain topics related to healthcare. Main DocumentsThe Health Care and Health Insurance Act (1992) - the Act stipulates that the state has to prevent and deal with the social problems of individuals, families and population groups. It includes a series of measures towards improvements in general health, preventive medicine, the early discovery of diseases and their prompt treatment, the care and rehabilitation of the sick and the injured, as well as rights relating to compulsory and voluntary health insurance for social security in case of illness, injury, childbirth or death. The rights pertaining to social security encompass measures and services intended for the prevention and abolition of social hardship, as well as contributions for individuals who cannot provide material security for themselves due to circumstances over which they have no influence.The Pension and Disability Insurance Act (1992) was first adopted in 1992 and in 1999 a new law came into force, which introduced pension reform and a new, 'three-pillar' pension system and disability insurance. The Act regulates compulsory pension and disability insurance on the basis of inter-generational solidarity, compulsory and voluntary additional pension and disability insurance, as well as pension and disability insurance on the basis of personal pension savings accounts.Legislation on health insurance, social security and pension insurance - A right to a decent lifeCompulsory health protection financed by employers and those insuredHealth insurance is compulsory for everybody with a permanent address in Slovenia. This insurance, paid by the insured, employers and other contributors bound by law, encompasses insurance for illness and injuries outside the workplace, as well as work injuries and professional diseases. It guarantees access to health services, medicines, technical aids, as well as sickness and other financial benefits. The extent of the right to health services is determined as a percentage of the total value of services rendered. This means that compulsory health insurance covers most health risks, but not all and not fully. The difference has to be paid by those insured out of their own pockets, or they can pay for additional insurance.The Health Insurance Institute, at its head office and regional units and branches throughout Slovenia, is responsible for managing health insurance. The Institute functions as an autonomous public finance body; its activities are managed by an assembly in which there are representatives of both employers and those insured.Voluntarily, according to the principle of equal rightsInsurance where inequalities are prohibitedIn 1999, a new Mutual Health Insurance organisation was established to manage voluntary health insurance, taking in all the 1.1 million people with voluntary insurance policies at the Institute of Health Insurance of Slovenia. A special feature of this insurance organisation is that it is owned by its members, those insured, and it functions according to the principles of mutuality and non-profitability. Everyone is guaranteed health insurance. For the older generation, which did not have the chance to pay health insurance, the insurance organisation guarantees health care through inter-generational agreement. Voluntary health insurance can be offered by other insurance companies, provided that it is organised as long-term insurance, that they insure everybody, irrespective of their state of health, and that the insurance company makes no distinctions between those insured. When voluntary health insurance was first introduced, in addition to the Health Insurance Institute, only one Slovene insurance company, Adriatic, joined the scheme. Insurance premiums can be paid either by the voluntarily insured individuals themselves or by their employers, trade unions, associations, or other organisations. Both insurance companies offer discounts for such group insurance policies and there are many instances of employers' collective insurance policies.Stable financing of health careAchieving reasonable health care within available meansThe Health Insurance Institute has for a number of years financed programmes of compulsory health insurance with approximately the same share of public funds: around 7 per cent of GDP, which is approximately 747 USD per capita. In 2003, the share of GDP spent on health was 9.14 % GDP (app. 1,235 USD). Each year the Ministry of Health Care and the Health Insurance Institute of Slovenia (Institute) take part in negotiations and agree upon the common scope of the programmes of health care services and the funds necessary to cover the programme, at the national level. The significance of the negotiations lies with a responsible determination of the "upper limits" for the public funds for health care, and responsible spending of financial means collected in a solidarity manner in the form of contributions for compulsory health insurance from all insured persons in Slovenia. In Slovenia, this upper limit was set to approximately 6.9% of the GNP. Thus in 2005, the total Institute expenditure in the realisation of the compulsory health insurance was approximately 1,749 billion Euros. This amount refers to the expenditure of (public) funds, collected on the basis of contributions paid by employers and employees, and by several other categories of contribution obligors. Slovene health capacities are comparable with those in the European Union. With regard to the financing of health care, funds earmarked for amortisation are to be increased, and additional funds provided for health care programmes and operations with very long waiting lists. More money is also to be spent on chemotherapy programmes in regional hospitals, on the widening of transplant programmes, on nursing-care wards in hospitals, health care in old people's homes, emergency medical help programmes, preventive programmes and programmes relating to the prevention and treatment of drug addiction. In addition to the public network of health institutions in Slovenia, private healthcare is also developing. Its share of the total health care services is around 10 per cent. Private health care is not permitted in some areas, such as blood supply, organ transplantation and pathology; whilst in other areas (for example, pharmacy, hospital health care, etc.) a concession is needed in order to be able to practice privately.Basic IndicatorsPOPULATION PROFILEat birth: 1.07 male(s)/female under 15 years: 1.06 male(s)/female 15-64 years: 1.02 male(s)/female 65 years and over: 0.63 male(s)/female total population: 0.95 male(s)/female (2006 est.)0-14 years: 13.8% (male 143,079/female 135,050) 15-64 years: 70.5% (male 714,393/female 702,950) 65 years and over: 15.7% (male 121,280/female 193,595) (2006 est.)total: 40.6 years male: 39 years female: 42.2 years (2006 est.)8.98 births/1,000 population (2006 est.) 10.31 deaths/1,000 population (2006 est.) HEALTH STATUS Life expectancy at birthtotal population: 76.33 years male: 72.63 years female: 80.29 years (2006 est.) gender diff.: 7.66 yearstotal: 4.4 deaths/1,000 live births male: 4.99 deaths/1,000 live births female: 3.77 deaths/1,000 live births (2006 est.)Disease burden (%)Neuropsychiatric disorders 26Cardiovascular diseases 17Malignant neoplasms 16 Causes of death (%)Cardiovascular diseases 41Malignant neoplasms 26Injuries 8 FINANCIAL AND HUMAN RESOURCES 9,14 % GDP (app. 1235 USD)Compulsory health insurance 6,7% GDP (73.1%)Voluntary health insurance for co-payments 1,2% BDP (13.3%)Direct payments 0,9% GDP (9.5%)State budged 0,3% GDP (4,0%)5%of the total workforce is employed in the health sector Health professionals per 1000 population:2.16 MD (0,5 GP; EU-15 average:1,02)7.1 registered nurses (EU-15 average: 6,7)6 dentists (EU-15 average: 6,4)3,9 pharmacists (EU-15 average: 7,9)Performances per 1000 population:6.4 visits15.6 prescribed drugs ORGANISATIONAL STRUCTURE HCSThree levels of care:primarysecondarytertiaryPublic providers of health care:primary health care centresgeneral and special hospitalclinics and institutesPrivate provision of health care:individual private practicescollective private practicessanatoria PRIMARY HEALTH CAREStructure63 Public Primary CentersPrivate providers (200 GP offices, 529 dental offices).Gate-keepers1243 GPs (+ 270 private): 0,45 per 1000 inhabitants157 Pediatricians (1 per 771 children to 6 years)174 Specialists in School Medicine (1 per 1505 school children from 7 to 19 years)545 Dentists (+ 556 private): 0,59 per 1000 inhabitants130 Gynecologists (1 per 6798 women)824 District nurses Allocation of moneyCapitation with age correctionIn 2005 socio-economic-demographic corrections were introduced.Grant for workersPublic sector: salary or capitation basis; some financial incentivesPrivate providers: concessions; regulations in accordance with Ministry of Health SECONDARY AND TERTIARY HEALTH CAREDistribution12 regional hospitals7 special hospitals5 psychiatric hospitals2 obstetric hospitals2 private sanatoriaVir / Source: CIA World FactbookContact Persons Mr. Dorjan Marušič, State Secretary Phone: +386 1 478 60 08 Fax: +386 1 478 60 74 E-mail: Dorjan.Marusic@gov.si Mrs. Natalija BERLEC, Head of the Minister's Office Phone: + 386 1 478 60 94 Fax: + 386 1 251 66 41 E-mail: natalija.berlec@gov.siMrs. Tatjana BRINC, M.Sc., Acting manager of General - Secretary Phone: + 386 1 478 60 20 Fax: + 386 1 478 60 67 E-mail: tatjana.brinc@gov.siMrs. Janja KRIŽMAN, Public Relations Office Phone: + 386 1 478 60 09 Fax: + 386 1 478 60 67 E-mail: janja.krizman@gov.siMrs. Irma Sterle Glaner Phone: + 386 1 478 60 40 Fax: + 386 1 478 60 67 E-mail: irma.glaner@gov.si Health Care Directorate Mr. Janez REMŠKAR, Director General Phone: +386 1 478 60 04 Fax: +386 1 251 77 55 E-mail: janez.remskar@gov.siPublic Health Directorate Mrs. Marija SELJAK, M.Sc., Director General Phone: + 386 1 478 60 07 Fax: + 386 1 478 60 79 E-mail: marija.seljak@gov.siPublic Health Care Economics Sector Mrs. Tatjana BRINC, M.Sc., Head of Sector Phone: +386 1 478 60 20 Fax: +386 1 478 69 67 E-mail: tatjana.brinc@gov.siPublic Health Care Investment Sector Mr. Dušan BLAGANJE, M.Sc., Head of Sector Phone: + 386 1 478 69 77 Fax: + 386 1 478 69 58 E-mail: dusan.blaganje@gov.siEU Affairs and International Cooperation Service Mrs. Zvezdana VEBER HARTMAN, Head of Service Phone: + 386 1 478 60 91 Fax: + 386 1 478 60 49 E-mail: zvezdana.veber-hartman@gov.siUseful LinksEuropean UnionEuropean Commission - Public HealthCouncil of EuropeWorld Health Organization - Regional Office for EuropeOZN / United NationsUNESCOAlpe AdriaGovernment of the Republic of SloveniaMinistry of Health of the Republic of Slovenia (currently available in Slovene only!) Agency of the Republic of Slovenia for Medical Products and Medical Remedies (currently available in Slovene only!) National Chemical Bureau of the Republic of Slovenia (currently available in Slovene only!) Health Inspectorate of Republic of Slovenia (currently available in Slovene only!) Radiation Protection Administration of the Republic of Slovenia (currently available in Slovene only!) The Health Insurance Institute of SloveniaInstiute of Public Health of Republic of SloveniaMedical Chamber of Slovenia (currently available in Slovene only!) The Slovenian Chamber of PharmacyNursing Chamber of Slovenia - Nurses Association of SloveniaSlovenian Association of Occupational Therapy (currently available in Slovene only!) Slovenian Medical Association (currently available in Slovene only!) Association of Medical Institutes of SloveniaUniversity Medical Centre Ljubljana (currently available in Slovene only!) The Institute of Oncology LjubljanaBlood Transfusion Centre of SloveniaInstitute for Rehabilitation (currently available in Slovene only!) Medical Faculty - University of LjubljanaMedical Faculty - University of Maribor (currently available in Slovene only!) College of Health Studies - University of ljubljana (currently available in Slovene only!) College of Health Studies - Izola (currently available in Slovene only!)
Ministry of Health (Ministrstvo za zdravje) Štefanova ulica 5 SI-1000 Ljubljana, Slovenia Phone: +386 1 478 60 01 Fax: +386 1 478 60 58 E-mail: gp.mz@gov.si Web Page: http://www.mz.gov.si/index.php?id=670&L=1 Organization Chart
The Slovenian health care system is based on the Bismarck-type of social health insurance and provides universal and comprehensive health care access to all Slovene citizens regardless of their income. In 2002, 8.3% of GDP was spent on health care, of this 74.9% came out of public sources. The rest came from the two main sources, the first and foremost, was voluntary health insurance, which in Slovenia's case is an insurance against co-payment and the second is out-of-pocket payments.
The main organizational features of the Slovenian health care system, the key actors and their relationships are derived from the historical development of the system and are further based on legislation introduced in 1992, the Health Care and Health Insurance Act and the Medical Services Act.
The Health Care and Health Insurance Act laid the basis for the present system of compulsory and voluntary health insurance, permitted privatization of health care, transferred some administrative functions to the professional chambers and established the basis for ongoing policy setting, strategic planning as well as development and implementation of disease prevention and health promotion programmes.
Among the main actors in Slovenian health care system are the Ministry of health, The Health Insurance Institute, The national Public health institute and professional organizations. There is but one insurer for compulsory health insurer, the Health Insurance Institute of Slovenia whose roles and position were defined by the Act.
The tasks of the Ministry of Health are to prepare legislation for health care and health protection and to ensure regulation and supervision of the implementation of legislation. The activities of the Ministry relate to health care at the primary, secondary and tertiary levels, including planning of public health care and the financing thereof. The Ministry furthermore monitors public health, prepares and implements health promotion programmes and ensures the conditions for people’s health education. Activities further focus on supervising the production, trade and supply of medicines and medicinal products and the manufacture, trade in illicit drugs. The Ministry is in charge of implementing international agreements on social security and of developing national health policies related to health care financing, health insurance benefits, quality assurance and planning of public health care facilities. The Ministry is responsible for establishing hospitals and public health facilities at the national level.
The Ministry has four offices, the Health Inspectorate, the Office for Medicinal Products, the National Chemicals Agency, the Slovenian Radiation Protection Administration (SRPA) and an expert counselling body, the Health Council.
The Health Insurance Institute of Slovenia, a public and not-for-profit entity supervised by the state, provides compulsory health insurance to the population. Voluntary health insurance, provided by a mutual insurance company Vzajemna and some private insurance companies, was introduced in 1993 to cover co-payments and to provide supplementary insurance.
The Institute of Public Health of the Republic of Slovenia with the nine regional public health institutes covers the fields of social medicine, hygiene, environmental health, epidemiology, health statistics and research activities. The most important activities of the national Public health Institute are to implement the national programme of prevention, to collect and analyse data on the health of the population and health care services and, based on reliable data, to prepare health policy documents and suggest measures to improve and protect health.
The health care delivery system is defined by the Medical Services Act. A GP gatekeeper system is in force which means that all referrals under the compulsory insurance are done by GPs. Some specialists are available at primary level and do not need referral, primary care paediatricians and primary care gynaecology services. GPs are reimbursed in half through capitation with 1850 persons per GP listed and the other half through fees-for-services delivered, half out of which need to be preventative. At the secondary level psychiatric services and services for venereal diseases do not require a referral. There are in total 26 hospitals, 12 of which are general hospitals, others are specialist hospitals, e.g. psychiatric, gynaecological, pulmology, etc. Hospitals are budgeted. The payment is based on number of cases and since 2004 there is variable part based on DRGs. The tertiary level includes university hospitals and institutes, performing highly specialized services, education, research, transfer of knowledge and development. In terms of delivery of services, there are public and private providers of health care services and both are reimbursed under the same principles. Most of the private practitioners work under concession on contract with the Health Insurance Institute of Slovenia. The only exception is dental services for adults where almost 15% work without concession and their patients pay for services in cash. The public health facilities at the secondary and tertiary level are owned ad administered by the State. Local governments of self-governing communities are responsible for planning, establishing and managing primary health care facilities, which is in part reflected in their responsibility for capital investment in public primary health care facilities and pharmacies.
Main priorities
The main priorities of the ministry are:
turn of the 15th century
Dr. Sanctorio Sanctori, a representative of late humanism in Slovenia, and a native of Koper, worked in Italy and introduced precise measurement - chiefly of body temperature - into medicine, and in his research on the digestive system he was also a forerunner of modern physiology.
1490
A milestone in Slovenian scientific history was the discovery of mercury in Idrija. Idrija became the second biggest mine of this metal in the world, after Almaden in Spain. The subsequent 500-year extraction of mercury in Idrija was a powerful stimulus to the development of science, medicine and technology in Slovenia and in the greater European continent.
First half of the 16th century
A famous physician and alchemist Paracelsus visited Idrija. He became the first to use mercury systematically as a medicine.
First half of the 18th century
Franc Anton Steinberg scientifically described the operation of the Idrija mercury mine.
Second half of the 18th century
Johann Anton Scopoli, a well-known physician from the Tyrol, and Balthazar Hacquet, a physician and natural scientist from Brittany, worked near the mine. Both of them described the mine in Idrija and its geological, technological and eco- logical properties in their works and passed on the knowledge of the particularities of Slovenia to Europe.
1887
Pension and disability insurance, the beginnings of which were connected to workers' funds, was first put into force within Austro-Hungarian imperium. The roots of the social security system on the territory of Slovenia thus show tradition of compulsory health insurance of more than 115 years.
1992
The Republic of Slovenia as an independent state adopted its own legislation in the field of health and social care and pension and disability insurance.
The Health Care and Health Insurance Act along with the Pension and Disability Insurance Act were adopted in the same year and later implemented.
Slovenia successfully joined both the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF).
BILATERAL COOPERATION
Slovenia has concluded several bilateral agreements on co-operation in the field of health and medicine, with a view to foster the exchange of information on several issues as the regulation of the health care and health insurance, the organization of health care activities, education and training of health proffessionals, health prevention and promotion. The agreements encourage also the exchange of experts for purpose of study and consultations as well as cooperation and common work on health related projects. Such agreements have been concluded up to now with Czech Republic, Slovak Republic, Albania, Israel, Kuwait, PR China, Russian Federation, Romania and Serbia and Montenegro, while several new agreements are envisaged to be concluded in the current year or in the year to come.
Ministry of Health has developed so far an intensive bilateral cooperation on the regional level, whether through the bilateral agreements, concluded between Slovenia and some European regions, or on the basis of the common work on projects. Thus the cooperation with Flanders, Wallonia, Bavaria, as well as cooperation within Alps-Adria Community and Interreg has been initiated or carried out.
MULTILATERAL - REGIONAL COOPERATION
Stability Pact for SEE
Health as a determining factor of social cohesion was included among the fields of activity of the Stability Pact for South Eastern Europe as early as in 2000. The year 2001 saw the adoption of the Action Plan of the Social Cohesion Initiative. In December of the same year, health ministers of South Eastern European countries signed the Dubrovnik Pledge on Meeting the Needs of Vulnerable Populations in South Eastern Europe, which represents a political consensus of South Eastern European countries on partnership cooperation in the field of health and on the provision of health services to vulnerable groups in the population of the region.
In 2001, seven recipient countries of assistance from the Stability Pact for South Eastern Europe established the South Eastern European Health Network, which was joined in the following year by Moldova and three neighbouring donor countries: Greece, Hungary and Slovenia. The South Eastern European Health Network supported by Council of Europe and the World Health Organisation's Regional Office for Europe, is an initiative whose aim is to promote and implement joint activities of recipient countries and donor-partner countries in projects in the spheres which are in their common interest, as well as to coordinate and evaluate the implementation of the aims set in the Dubrovnik Pledge.
Being aware of the importance of social cohesion for economic and general development, and for stability in the region of South Eastern Europe, the Republic of Slovenia decided in 2002 to join the group of donor countries that supports the implementation of the projects by providing technical expertise and financial assistance.
To date, seven project proposals have been put forward, of which six are actually being carried out, i.e. projects in the fields of mental health, safety of foodstuffs, communicable diseases, blood safety, tobacco control and emergency health services.
The Republic of Slovenia is determined to continue providing support for the activities of the South Eastern European Health Network, subject to the available scope of its expert knowledge and funds, and thus to contribute to a faster and successful development of the South Eastern European countries in the field of health, health systems and medicine.
The Alps-Adriatic Working Community
The Ministry participates in the activities and projects of the Commission IV for Health and Social Welfare with the priority of promoting the implementation of International ICF Classification in the Alps-Adriatic region and develop common language on disability.
UNITED NATIONS ORGANISATIONS AND SPECIALISED AGENCIES
World Health Organization - WHO
Slovenia became a member of the WHO in 1993. Since than, many projects, programs and strategies have been successfully developed and implemented in Slovenia in co-operation with WHO EURO (Healthy cities network, Health schools network, Food and nutrition action plan, Health impact assessment of agriculture policy, etc). Four WHO collaborative centres operate in Slovenia, covering areas of mental health of children, arbo-viruses and hemorrhagic fever, nursing and reproductive health. In the last few years the main topic of cooperation was the reforming of health care. The main priorities of cooperation with WHO EURO in 2004/2005are:
1. Health system infrastructure development, including:
2. Quality in health care, including:
3. Investment for health - linking the development of most disadvantaged region in Slovenia, Pomurje, with health.
In co-operation with WHO Slovenia is performing as a donor in the Stability Pact for SEE Countries. Slovenia is among those members of WHO that have already ratified the Framework Convention on Tobacco Control.
UNESCO AND OTHER UN ORGANISATIONS AND SPECIALISED AGENCIES
The Ministry of Health participates in the activities of the Division of Ethics of Science and Technology of the UNESCO. The Ministry cooperates with the Ministry of Labour, Family and Social affairs in reporting about the implementation of ratified conventions of United Nations Organisation and United Nations Specialised Agencies, especially the International Labour Organisation.
The Ministry of Health implements also resolutions, adopted by the United Nations Commission on Human Rights, which cover the field of health protection.
OTHER INTERNATIONAL ORGANISATIONS
COUNCIL OF EUROPE
Health, ethics and human rights
“When we speak about human rights, we rarely think about people being treated in hospitals and clinics, visited by doctors and nurses, or resting in homes for senior citizens. Yet, the ever-evolving concept of human rights and our understanding of it have been constantly enlarging their scope over recent decades. Through this evolution in our thinking and vision, we have come to realise that the right to good health and its protection is as much a human right as other commonly recognised rights and freedoms,” said Ms Maud de Boer-Buquicchio, the Deputy Secretary General when the European Health Committee celebrated its 50th anniversary in 2004.
The Ministry of Health actively participates in the intergovernmental activities of the European Health Committee and the Steering Committee on Bioethics and joins international efforts to promote and implement the concept of human rights and health globally and nationally. Main activities of the European Health Committee are related to equity in access to health care and health promotion, patient’s rights and citizen participation and availability of and access to safe and good quality health care services. Slovenia has signed and ratified the European Agreements related to the healthcare field and the Convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine: Convention on human rights and biomedicine with Additional protocols. The Ministry of Health is responsible for the implementation.
The Ministry participates in the activities of the Partial Agreements:
The Pension and Disability Insurance Act (1992) was first adopted in 1992 and in 1999 a new law came into force, which introduced pension reform and a new, 'three-pillar' pension system and disability insurance. The Act regulates compulsory pension and disability insurance on the basis of inter-generational solidarity, compulsory and voluntary additional pension and disability insurance, as well as pension and disability insurance on the basis of personal pension savings accounts.
Legislation on health insurance, social security and pension insurance - A right to a decent life
Compulsory health protection financed by employers and those insured
Health insurance is compulsory for everybody with a permanent address in Slovenia. This insurance, paid by the insured, employers and other contributors bound by law, encompasses insurance for illness and injuries outside the workplace, as well as work injuries and professional diseases. It guarantees access to health services, medicines, technical aids, as well as sickness and other financial benefits. The extent of the right to health services is determined as a percentage of the total value of services rendered. This means that compulsory health insurance covers most health risks, but not all and not fully. The difference has to be paid by those insured out of their own pockets, or they can pay for additional insurance.
The Health Insurance Institute, at its head office and regional units and branches throughout Slovenia, is responsible for managing health insurance. The Institute functions as an autonomous public finance body; its activities are managed by an assembly in which there are representatives of both employers and those insured.
Voluntarily, according to the principle of equal rights
Insurance where inequalities are prohibited
In 1999, a new Mutual Health Insurance organisation was established to manage voluntary health insurance, taking in all the 1.1 million people with voluntary insurance policies at the Institute of Health Insurance of Slovenia. A special feature of this insurance organisation is that it is owned by its members, those insured, and it functions according to the principles of mutuality and non-profitability.
Everyone is guaranteed health insurance. For the older generation, which did not have the chance to pay health insurance, the insurance organisation guarantees health care through inter-generational agreement. Voluntary health insurance can be offered by other insurance companies, provided that it is organised as long-term insurance, that they insure everybody, irrespective of their state of health, and that the insurance company makes no distinctions between those insured. When voluntary health insurance was first introduced, in addition to the Health Insurance Institute, only one Slovene insurance company, Adriatic, joined the scheme. Insurance premiums can be paid either by the voluntarily insured individuals themselves or by their employers, trade unions, associations, or other organisations. Both insurance companies offer discounts for such group insurance policies and there are many instances of employers' collective insurance policies.
Stable financing of health care
Achieving reasonable health care within available means
The Health Insurance Institute has for a number of years financed programmes of compulsory health insurance with approximately the same share of public funds: around 7 per cent of GDP, which is approximately 747 USD per capita. In 2003, the share of GDP spent on health was 9.14 % GDP (app. 1,235 USD). Each year the Ministry of Health Care and the Health Insurance Institute of Slovenia (Institute) take part in negotiations and agree upon the common scope of the programmes of health care services and the funds necessary to cover the programme, at the national level. The significance of the negotiations lies with a responsible determination of the "upper limits" for the public funds for health care, and responsible spending of financial means collected in a solidarity manner in the form of contributions for compulsory health insurance from all insured persons in Slovenia. In Slovenia, this upper limit was set to approximately 6.9% of the GNP. Thus in 2005, the total Institute expenditure in the realisation of the compulsory health insurance was approximately 1,749 billion Euros. This amount refers to the expenditure of (public) funds, collected on the basis of contributions paid by employers and employees, and by several other categories of contribution obligors. Slovene health capacities are comparable with those in the European Union. With regard to the financing of health care, funds earmarked for amortisation are to be increased, and additional funds provided for health care programmes and operations with very long waiting lists. More money is also to be spent on chemotherapy programmes in regional hospitals, on the widening of transplant programmes, on nursing-care wards in hospitals, health care in old people's homes, emergency medical help programmes, preventive programmes and programmes relating to the prevention and treatment of drug addiction. In addition to the public network of health institutions in Slovenia, private healthcare is also developing. Its share of the total health care services is around 10 per cent. Private health care is not permitted in some areas, such as blood supply, organ transplantation and pathology; whilst in other areas (for example, pharmacy, hospital health care, etc.) a concession is needed in order to be able to practice privately.
POPULATION PROFILE
at birth: 1.07 male(s)/female under 15 years: 1.06 male(s)/female 15-64 years: 1.02 male(s)/female 65 years and over: 0.63 male(s)/female total population: 0.95 male(s)/female (2006 est.)
0-14 years: 13.8% (male 143,079/female 135,050) 15-64 years: 70.5% (male 714,393/female 702,950) 65 years and over: 15.7% (male 121,280/female 193,595) (2006 est.)
total: 40.6 years male: 39 years female: 42.2 years (2006 est.)
8.98 births/1,000 population (2006 est.) 10.31 deaths/1,000 population (2006 est.)
HEALTH STATUS
Life expectancy at birth
total population: 76.33 years male: 72.63 years female: 80.29 years (2006 est.) gender diff.: 7.66 years
total: 4.4 deaths/1,000 live births male: 4.99 deaths/1,000 live births female: 3.77 deaths/1,000 live births (2006 est.)
Disease burden (%)
Causes of death (%)
FINANCIAL AND HUMAN RESOURCES
9,14 % GDP (app. 1235 USD)
5%of the total workforce is employed in the health sector
Health professionals per 1000 population:
Performances per 1000 population:
ORGANISATIONAL STRUCTURE HCS
Three levels of care:
Public providers of health care:
Private provision of health care:
PRIMARY HEALTH CARE
Structure
Gate-keepers
Allocation of money
Grant for workers
SECONDARY AND TERTIARY HEALTH CARE
Distribution
Vir / Source: CIA World Factbook
Mrs. Natalija BERLEC, Head of the Minister's Office Phone: + 386 1 478 60 94 Fax: + 386 1 251 66 41 E-mail: natalija.berlec@gov.si
Mrs. Tatjana BRINC, M.Sc., Acting manager of General - Secretary Phone: + 386 1 478 60 20 Fax: + 386 1 478 60 67 E-mail: tatjana.brinc@gov.si
Mrs. Janja KRIŽMAN, Public Relations Office Phone: + 386 1 478 60 09 Fax: + 386 1 478 60 67 E-mail: janja.krizman@gov.si
Mrs. Irma Sterle Glaner Phone: + 386 1 478 60 40 Fax: + 386 1 478 60 67 E-mail: irma.glaner@gov.si Health Care Directorate Mr. Janez REMŠKAR, Director General Phone: +386 1 478 60 04 Fax: +386 1 251 77 55 E-mail: janez.remskar@gov.si
Public Health Directorate Mrs. Marija SELJAK, M.Sc., Director General Phone: + 386 1 478 60 07 Fax: + 386 1 478 60 79 E-mail: marija.seljak@gov.si
Public Health Care Economics Sector Mrs. Tatjana BRINC, M.Sc., Head of Sector Phone: +386 1 478 60 20 Fax: +386 1 478 69 67 E-mail: tatjana.brinc@gov.si
Public Health Care Investment Sector Mr. Dušan BLAGANJE, M.Sc., Head of Sector Phone: + 386 1 478 69 77 Fax: + 386 1 478 69 58 E-mail: dusan.blaganje@gov.si
EU Affairs and International Cooperation Service Mrs. Zvezdana VEBER HARTMAN, Head of Service Phone: + 386 1 478 60 91 Fax: + 386 1 478 60 49 E-mail: zvezdana.veber-hartman@gov.si