Slovenia, 16.6.2005

Rudolf Zajac

Healthcare Reform in Slovakia

Slovenia, 16.6.2005

I. Introduction - Slovakia

Population: 5.4 million people

Living Standard: 51% of EU average

Middle income country

Slovenia, 16.6.2005

Expenditure on Health Care

0,00

2,00

4,00

6,00

8,00

10,00

12,00

14,00

0 5000 10000 15000 20000 25000 30000 35000 40000

GDP per capita at PPP in USD

Expenditure on health care as % of GDP

source: OECD

ROM

IRE

SVKCZ

USA

GER

DEN

ESP

Slovenia, 16.6.2005

Deficit of Public Finances (% of GDP)

-3,6 -3,4

-0,5-0,9 -0,9 -0,8

-0,4 -0,2

-5,3

-4,1

-2,0

-3,6 -3,6

-6,6-6,1

-7,5

-6,4

0,0

-8,0

-7,0

-6,0

-5,0

-4,0

-3,0

-2,0

-1,0

0,0

1999 2000 2001 2002 2003 2004 2005

GFS 86ESA 95Health care

Slovenia, 16.6.2005

Breakdown of Current System

reso

urce

s:

resources:0

47 (payroll taxes)

23 (taxes)

8

excess of solidarity over resources

solidarity

solidarity

17 (informal payments)

(direct payments)

5 (income from privatisation)

Slovenia, 16.6.2005

Consequences

Volume

Pri

ces

/ sp

end

ing

1

1

2

Expenditure

Infinite demand

3

3

Excess of demand over supply

Slovenia, 16.6.2005

Efficiency gap

0,000

0,100

0,200

0,300

0,400

0,500

0,600

0,700

0,800

0,900

1,000

0,000 0,200 0,400 0,600 0,800 1,000

Input

Ou

tpu

t

Through corrections in pay levels, employment and age structure it RISES to a

ratio of:Input : Output0,526 : 0,612

CZ

HUN

LUX

SVK

Slovenia, 16.6.2005

Efficiency in Health Care

Efficiency = 1.000 Efficiency = 0.612

The Netherlands Slovakia

Slovenia, 16.6.2005

Slovakia, the leader in Reforms?

I. Tax Reform (2003) – Corporate and Wage Tax – 19 %

II. Pension Reform (2003) – Two pillars (public and private)

III. Public Administration Reform (2004) – Fiscal Decentralization

IV. Labour Market Reform (2003) – Modern Labour Code

V. Health Care Reform - Stabilization (2003) - Reform Acts (2004)

Slovenia, 16.6.2005

Pre-reform "preparation" of citizens, or stabilisation (June 2003)

Application of marginal co-payments

Patient Health Insurance

Fund

Provider (pharmacy)

Primary care 20 Sk 0 Sk 20 Sk

Secondary care 20 Sk 0 Sk 20 Sk

Accomodation and food in inpatient care

50 Sk 0 Sk 50 Sk

Transport 2 Sk/km

Prescription fee 20 Sk 15 Sk 5 Sk

Slovenia, 16.6.2005

The Reform Jigsaw

Healthcare legislation and supervision of health care

Health Insurance Act

Healthcare Emergency Services Act

Healthcare Act

Healthcare Providers and Professional

Bodies Act

Act on the Scopeof Health Care Covered by PublicHealth Insurance

Slovenia, 16.6.2005

Principles of Reform

1. Equal care for equal need

2. Ability to pay

3. Universal coverage

4. Protection of patients' rights

5. Enforcement of fair play

6. Health care is a technical service and an ethical vocation

7. Guaranteed free access for licensed providers to the healthcare market

Slovenia, 16.6.2005

Main Philosophial Changes

Increased responsibility of health insurers for the purchase of health care and the financial protection of the patient

Increased responsibility of providers for health care provision

Increased responsibility of patients for their health

Slovenia, 16.6.2005

Health Care

Basic principle:

Health care is a technical service and an ethical vocation

Slovenia, 16.6.2005

Clear definitions and rules

1. Definition of procedure "lege artis" 2. Definition of urgent treatment3. Definition of informed consent4. Access to and provision of medical records and protection

of patients' personal information5. Catalogues of actions leading to diagnosis and treatments

leading to the cure of illnesses (see the law on scope)

6. Integrated European Charter of Patients' Rights (e.g. the right to choose a provider, to respectful treatment of patient by doctor, to information on their health condition,...)

7. Principles of bioethics (transplantation, sterilisation, biomedical research)

Slovenia, 16.6.2005

Health insurance

Respects: solidarity ability to pay

Must ensure: universal coverage without regard to

the social status of the recipient

Slovenia, 16.6.2005

Health insurance

Individual health insurance

Public health insurance (solidarity)

Emp 10+4%

Covers individual needs, optional

Scope set by special legislation, compulsory

Slovenia, 16.6.2005

Redistribution according to rating of costs (risk)

0

1

2

3

4

5

6

0 to

4

5 to

9

10 to

14

15 to

19

20 to

24

25 to

29

30 to

34

35 to

39

40 to

44

45 to

49

50 to

54

55 to

59

60 to

64

65 to

69

70 to

74

75 to

79

over

80

risk level - women

risk level - men

Objective: for all insured to have access to an equal volume of resources corresponding their risk rating

Slovenia, 16.6.2005

Healthcare legislation and supervision of health care

Health insurers Duty to provide health insurance Option of individual insurance Option of sickness insurance Transformation of the current public institutions into

joint stock companies

Supervisory office Issues permission (licenses) to health insurers Monitors the solvency of health insurers Supervises and monitors

a) whether insurers have purchased health carein the scope required by law

b) whether providers have provided it "lege artis"

Slovenia, 16.6.2005

Multiple insurers – yes or no?

REDISTRIBUTION

PURCHASE OF HC

SELECTION

SELECTION

SELECTION

PURCHASE OF HC

PURCHASE OF HC

Slovenia, 16.6.2005

Instruments of Purchase

Health insurance provider

Selection of provider by quality and price

Quality standards

The law does not stipulate the payment mechanism to be used

Slovenia, 16.6.2005

Objective: to increase the responsibility of the insurer

Patient Health insurance provider

MD (GP, Specialist)

Hospital

Patient Management

Slovenia, 16.6.2005

Healthcare Emergency Services

Part of the integrated emergency system (IES)

Organisation of a network of healthcare emergency services so that in cooperation with IES, 98% of citizens can be reached in under 10 minutes

Slovenia, 16.6.2005

Healthcare Providers Act

Basic principles: Ensure free access to authorised (licensed) providers Transfer the performance of first level state

administration to professional bodies The act contains an ethical codex for providers,

obligation to provide lifelong learning and monitoring Transforms the largest hospitals into joint stock

companies whose shareholders will be universities, towns and regions

Slovenia, 16.6.2005

Act on Scope

Basic principle:

Equal care for equal need

Slovenia, 16.6.2005

List of citizens' prioritiesIllness %

Hear-circulatory illnesses 74,2

Cancer 68,8

Diabetes and defects in metabolism 26,2

Illnesses of the locomotive organs 16,6

Psychological, Psychiatric, Neurological and Stress-related Illnesses

16,1

Flu 12,1

Allergies 10,9

Bronchial illnesses 8,6

Infectious diseases, hepatitis, TB and AIDS 6,3

Bad lifestyle, obesity 6,2

Alcoholism, smoking, drug abuse 4,6

Stomatological problems 1,4

Skin diseases 0,9

Gynecological illnesses 0,8

source: FOCUS, January

2004

Slovenia, 16.6.2005

Categorisation criteria (§ 9)

The categorisation of diagnoses takes into consideration:

the seriousness of the illness, the ability of diverse groups of patients

to cofinance their treatment*

* - the amount contributed by the insured can depend on symptoms, age and the priorities of health policy.

Slovenia, 16.6.2005

Catalogues of actions

ILLNESS

Establishment of a standard diagnostic and therapeutic procedure(Act on Health Care)

Actions leading to the cure of illness (treatment actions)

Actions leading to the diagnosis of illness

(diagnostic actions)

Slovenia, 16.6.2005

Categorisation model

1

2

3

...

cca 9 000

ACTIONS

ILLNESSES

- actions fully covered

- actions not covered

- actions partly covered

Slovenia, 16.6.2005

Social Balance

The amount that citizens contribute does not change,

but the structure of expenditure changes

according to priorities.

Slovenia, 16.6.2005

PARLIAMENT

123

...

cca 9 000

ILLNESSES

Categorisation Model in Use

Optimal level Cofinancing

- payment by pulic insurer

- cofinancing by patient

Critical risks:

financial protection of patients against the risk of high costs

urgent treatment chronic illnesses

insurers

expertsthe ministry

High level of cofinancing

Low level of cofinancing

Slovenia, 16.6.2005

Patient's responsibility

Specification of the patient's responsibility for prevention and adherence to the treatment programme

The health insurer has the right To enforce claims against the insured for repayment

of costs of health care where it was demonstrably provided as a result of a breach in a treatment programme or the use of an addictive substance,

To pay the insured partial costs corresponding to the cofinancing by the patient if the insured regularly receives a preventative check-up, innoculations and follows a healthy lifestyle.

Slovenia, 16.6.2005

Role of political decisions

What resources

?

Increase effectiveness

and

decrease the expectations

of citizens

What benefits

?

Efficiency

1,000

Netherlands Slovakia

0,612

Slovenia, 16.6.2005

NEW PLAYERS

Health insurer

Providers

Emergency services

Prof. Bodies

of Health Care

ScopeRegional

govt., SR MH

HI Supervision

Finances

Supervisory office

Finances

Finances HI Supervision

Permission Licence

Permission Licence

Slovenia, 16.6.2005

... ??? ...We're lucky that the hole is not on our side

Slovenia, 16.6.2005

THANK YOU FOR LISTENING

We welcome your comments

and you can obtain further information from

www.zdravotnictvo.sk

and

www.reformazdravotnictva.sk