Official law database that combines 15 national databases Slovenian government office for legislation

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1 Slovenia European Region Updated: February 2017 This document contains links to websites where you can find national legislation and health laws. We link to official government legal sources wherever possible. Where we link to unofficial sources this is noted and users should take this into account before relying on these materials. We recommend checking with the relevant national government if you have questions about the currency or validity of any unofficial source of law. Legal system Civil law National law database Language: Link: Nature: Organisation responsible for the website: Slovene and English Official law database that combines 15 national databases Slovenian government office for legislation Legal UHC start date 1992 Source: data/assets/pdf_file/0005/96368/e76966.pdf The health system and policy monitor: regulation (PDF) As part of its Health Systems in Transition (HiT) series the European Observatory on Health Systems and Policies systematically describes the functioning of health systems in countries as well as reform and policy initiatives in progress or under development. The HiT health system reviews cover the countries of the WHO European Region as well as some additional OECD countries. This PDF includes information about the country s regulation. To see the complete HiT report of this country go to:

2 Search list of contents: Regulation Overview and publication details 2 Regulation Slovenia 3 Page 1/6

3 Regulation Slovenia HIT: Albreht T, Turk E, Toth M, Ceglar J, Marn S, Pribaković Brinovec R, Schäfer M, Avdeeva O, Van Ginneken E HSPM Members: IVZ, Institute of Public Health of the Republic of Slovenia HSPM Contributors: Albreht T, Pribaković Brinovec R, Panteli D Page 2/6

4 Slovenia: Regulation 4. Regulation and planning 4.1 Regulation T he Slovene health care system has characteristics of both the integrated and the contract model of health care systems. Services carried out are paid by the HIIS based on the contract between the HIIS and the public health care provider (for example, primary care centres). In addition, most private providers are contracted by the HIIS and are part of the public health care network Regulation and governance of third-party payers Third-party payers are regulated by the Government and Parliament, monitored by the Ministry of Health, the Health Council and the IPH-RS, and are administered by the HIIS and VHI companies. Annual partnership negotiations result in specifying the national priorities in terms of health care programmes; volume and cost of health care programmes; capacities for providing health services; payment mechanisms; process of tenders and selection of providers; supervision processes and other rights and responsibilities of the health care partners in terms of services provision; data reporting; and services financing. The general agreement and special agreements for different groups of health care providers are the key products of the first phase of the contracting process, which are subsequently used directly in the individual contracting process between the HIIS and each provider, to determining the final content of the contract Regulation and governance of providers The provision of services is regulated by the general agreement and the special agreement signed between the HIIS and the provider. The agreements specify the type and volume of services to be provided, the cost and/or prices of the services, methods of payment, quality requirements and conditions for monitoring the contract implementation, and the individual rights and responsibilities of the contracting parties. Except in the case of dialysis services and the transplantation programme, the payments for provided health services are prospectively defined and capped, which means that health services provided above the prospectively determined plans are not reimbursed by the HIIS. If the HIIS and a provider do not reach agreement within the framework of the general agreement and the special agreement, both the purchaser (HIIS) and the provider are entitled to initiate the process of arbitration, after which the final decision is adopted by the HIIS, the provider and the Ministry of Health. Health care providers can be categorized as providers, on an individual level (that is, medical doctors, nurses, dentists and pharmacists) and providers, on an institutional level (hospitals, rehabilitative centre and primary care centres). Individual providers are regulated by professional chambers and are financed by third-party payers. Institutional providers (such as hospitals) are regulated through legislation adopted according to the policies of the Ministry of Health and financed by third-party payers. Local governments are responsible for regulating health services at the primary care level within their respective communities. It is the responsibility of the local community to grant concessions for private health care providers at the primary health care level (with the consent of the Ministry of Health). Such a concession is a public contract, which ensures inclusion into the network of publicly financed health care providers, agreed for an indefinite period and with each party having the right to withdraw (with certain limitations and restrictions). The concession is necessary only for those services and for those practitioners that wish to be reimbursed for their services by compulsory health insurance and/or VHI. Those who are not reimbursed from compulsory health insurance funds can only offer services to patients who pay out of pocket for care. Once a concession has been granted and the contract signed, providers approach the HIIS to define the terms of the contract with regard to the provision, extent and reimbursement of services. The contract with the HIIS puts the private provider of health care at the same Page 3/6

5 level as any public provider, in terms of rights. The only difference lies in the fact that a private provider cannot apply for public funds for capital investments. The Medical Chamber and the Pharmaceutical Chamber are empowered by law to a high level of selfregulation and autonomy. They have control over professional advancements, including professional auditing and licensing of physicians, dentists, pharmacists and nurses. Moreover, these chambers are responsible for supervising, monitoring and ensuring the quality of care as defined by the relevant legislation for each of the fields (such as the Medical Services Act and the Pharmacy Services Act). Other professional associations (such as the medical societies) also play an important role in organizing professional (postgraduate) training, in adopting professional instructions and monitoring their implementation. Health care providers can be classified as integrated both at the secondary and tertiary care levels. Providers at both the clinical centre level and at the hospital level are directly employed or owned by third-party payers and have the status of public employees, although they are engaged in employment relationships with their employer and paid in accordance with the collective agreement. The majority of providers at the primary care level are contracted by the HIIS and are still employed in health centres, while a smaller group of them work in private practices; however, this system is in transition at the time of writing. Privatization, which has developed in the direction of the termination of the employment relationship by medical doctors and other medical workers from public service and the opening of their own practices, is taking place gradually but to a constantly increasing extent (for more information on this issue see Section 2.4 Decentralization of the health care system). At the end of 2006 only 190 doctors and dentists were practising outside the public system (that is, without a concession). While there is no information available as to the share of total expenditure contributed via direct payments made by patients, according to anecdotal evidence patients are increasingly making OOP payments for visits to physicians without concessions in private practices and for the purchase of services which are not included in their benefits package. Of the 1279 physicians licensed for private practice since 1992, 1089 are contracted by one of the 10 regional social insurance funds (Medical Chamber 2006). These licensed professionals use public premises for their practices and their services are to a large extent reimbursable by insurance funds. Apart from private practices, private practitioners practising independently can also be found in homes for the elderly, other social institutions and pharmacies. Health care provider institutions are governed by internal regulations of institutions according to the public health care network and by contracts between third-party payers and health care providers. Health care provider institutions include outpatient clinics and health centres at the primary level and specialist outpatient departments and hospitals at the secondary and tertiary levels. Hospitals and health centres are managed by the directors of the respective institutions, under supervision by the Ministry of Health for secondary and tertiary care and by the local communities for primary care. The State is the owner and administrator of public health facilities at the secondary and tertiary levels. For more information on hospitals and health sector infrastructure, see Chapter 5 Physical and human resources Regulating quality of care Since publication of the document The quality of the health care system in the Republic of Slovenia (Kersnik 2001) and a chapter on quality in health care in the Health Care Reform White Paper (Ministry of Health 2003), much attention has been given to a systematically developed national system of quality and safety in health care. This was the main task of a newly established Department for Quality in Health Care at the Ministry of Health in The first tangible output of the department was the publication of generic accreditation standards for hospitals and an accompanying programme of accreditation, as well as a document for the implementation of self-assessment. However, due to (amongst other things) strong opposition by providers, the programme on accreditation has not yet been implemented at the time of writing (early 2009). In 2002 a first set of data on clinical indicators became available. This was a joint project of the Medical Chamber of Slovenia, the HIIS and the Ministry of Health. The programme was voluntary and Page 4/6

6 encompassed 48 clinical specialties as well as one single indicator on arterial hypertension at the primary care level. The Slovene Manual on the Development of Clinical Practice Guidelines has been distributed to clinical guidelines groups and two national guidelines were developed in Guidelines are developed mainly by the Slovene Medical Association. In the same year, clinical pathways were established and implemented in four public hospitals. In 2004 approximately 15% of case types were managed with the use of clinical pathways (Hindle & Yazbeck 2005). There has been a constant increase in clinical pathway development and implementation. A survey conducted in 2006 showed that from 2004 to the end of 2006 half of the country s hospitals were using clinical pathways (Yazbeck & Robida 2006a). The development and implementation of clinical pathways will be further promoted with additional help of the policy document Methodological recommendations for clinical pathways development (Yazbeck & Robida 2006b). The National Policy for the Development of Quality in Health Care was published by the Ministry of Health in Its purpose is to encourage health care providers, managers of health care organizations, health care insurance companies, educational health care organizations, health care professionals, patients and other stakeholders to improve the quality of care and patient safety. A National Institute for Quality in Health Care was also proposed, with the main tasks of coordinating domains of continuous quality improvement, such as clinical guidelines and pathways, standards and indicators development, training and research and accreditation of health care providers. Obligatory requirements regarding structure, processes, business, efficacy, continuing professional development indicators and clinical indicators were approved in the Hospital Agreement for the year 2007 (HIIS 2007b). Boards and quality commissions were established in all public hospitals. Hospitals are required to submit reports on the following clinical indicators: patient falls, pressure ulcers, re-admissions, incidence of Methicillin-resistant Staphylococcus aureus (MRSA), patient experience and staff satisfaction. A national survey on patient experience was conducted in 2006 with more than 7000 participants across the country s hospitals. The following domains of patient experience were measured: timeliness of hospital admission, communication of health professionals with patients, information of patients on their health status and proposed treatment, patient participation in treatment decisions, pain management, and hospital environment. It showed that the average score on a scale from 0 to 100 was 86 points (0 denoting bad experiences, 100 points indicating excellent experiences). The main areas for improvement are the quality of doctor patient communication (including appropriate information on patient rights), observation of patients privacy, reduction of waiting times, improvement of hospital nutrition and observation of patients night rest (Ministry of Health 2007a). Since 2007, hospitals are required to further introduce quality and safety improvement processes: amongst other things, these include patient safety leadership walk rounds, patient safety talks, morbidity and mortality meetings, internal audits and management of clinical documentation. Moreover, some hospitals and primary health care centres were certified for ISO 9001:2000 (for example, the Centre for Blood Transfusion in 2004 and the Department for Immunohematology and Blood Transfusion Medicine of the University clinical centre in Maribor in 2006). In 2002, the Ministry of Health introduced a sentinel events reporting system. However, due to its voluntary nature most of the providers ignore this reporting system. Patient safety has not yet become a priority in many health care organizations. An integrated reporting and learning system for patient safety incidents has not been systematically developed yet. Likewise, clinical risk management is not part of a quality management system. The medical negligence legislation (Medical Services Act, 1999) is in place and there is an obligatory insurance scheme for providers of health care. Court decisions for patient safety incidents are increasing in number, but are still relatively rare and in most instances unsuccessful for patients as they can get financial compensation only if medical failure is proven by court decision. Currently, there are no financial incentives for the implementation of quality and patient safety measures. However, during the last five years, some professional groups have taken up the idea of quality and safety in health care and implemented it into their daily practice; however, quality and safety is still not the top priority of many health care organizations and professionals. Page 5/6

7 Legislation on quality and safety and the establishment of a national coordinating institute for quality and safety is necessary to guarantee implementation, sustainability and further development of quality and safety in the Slovene health care system. Page 6/6