SLOVENIA
SPAIN
Mr Simon Vrhunec
HOPE Governor, Association of Health Institutions
of Slovenia Mrs Sara Pupato Ferrari
HOPE Governor, Ministry of Health, Social Services
and Equality
Could you describe the last hospital and/
or healthcare reforms implemented in your
country in the past 5 years?
Slovenia is still among the countries in the EU
that spend less than average on healthcare. If EU
average health expenditure is 9.6% of GDP in 2017
(Health at a Glance: Europe 2018), in Slovenia it
was only 8.0% of GDP the same year. In addition
to the lack of financing resources Slovenia is
facing also a lack of practicing doctors. In
Slovenia there are 3 practising doctors per 1000
population while the EU average is 3.6 (Health at
a Glance: Europe 2018). Only with practising
nurses is the situation slightly better, because this
figure is above the EU average in Slovenia.
A lack of resources in the Slovenian healthcare
system results in long waiting times for specialist
outpatient care. Some waiting times exceed a year
and 40% of those who are waiting for a specialist
outpatient service are waiting more than it is
considered acceptable. Despite those facts, in
politics there is still a very strong opinion that the
main cause for long waiting times is corruption
and not lack of resources, which is why no serious
reform was implemented in the last five years.
The only change of health law was to prevent
(forbid) doctors to work for different employers
and to decrease the validity of concessions from
an indefinite term to 15 years. Could you describe the last hospital and/
or healthcare reforms implemented in your
country in the past 5 years?
Central procurement in the National Health
System
On December 2001, the transfer of managerial
processes regarding the National Healthcare
System concluded with the decentralisation of
decision-making centres to the 17 Autonomous
Communities (CCAAs), the National Healthcare
System itself and the National Health
Management Institute (INGESA).
The decentralisation brought a very
fragmented, opaque and, in some way, inefficient
procurement market policies that required
a rationalisation of the procurement system.
A Central Purchasing Unit dealing with all the
National Healthcare System procurement
procedures was considered a useful alternative
for that, with the aim of:
• Ensuring equity and cohesion through the
implementation of new quality standards and
technical criteria that every product should
comply with;
• Promoting transparent procurement policies
and easing market competition;
• Gaining efficiency and increasing budget
savings.
During 2014, pharmaceutical products
restricted to hospital use were declared as
central procurement system products and INGESA
was entrusted to develop the acquisition
procedures. From 2015, most CCAAs (the
exceptions being the Basque Country, Catalonia,
Andalusia and the Canary Islands) have supported
and participated in the emerging acquisition
system replacing old punctual acquisition
agreements and a Central Procurement Agency
was implanted in INGESA aiming to get the
support of the CCAAs. Despite the achievements,
centralised procurement raised several issues and
was partially used.
Could you present two/three elements on
the impact of such reforms on hospital and/
or healthcare sectors that your organisation/
country has identified?
Because the healthcare legislation was changed
only one and a half year ago and the providers are
still inside the three-year period to adopt the
changes, there are no elements of the impact
present. But the expectation is that restrictions
for doctors to work on different locations will
result in increasing waiting times and not the
opposite.
A lack of
resources in
the Slovenian
healthcare
system results
in long
waiting times
for specialist
outpatient care
SLOVENIA
Total current health expenditure as % of Gross Domestic Product (GDP)
General government/compulsory current health expenditure as % of total current health expenditure
Hospital current health expenditure, as % of total current health expenditure
Household out-of-pocket health expenditure as % of total current health expenditure
All hospital beds per 100,000 inhabitants
Acute care hospital beds per 100,000 inhabitants
Acute care admissions/discharges per 100 inhabitants
Average length of stay for acute care hospitals (bed-days)
Practising physicians per 100,000 inhabitants
Practising nurses per 100,000 inhabitants
21
HHE 2019 | hospitalhealthcare.com
2002
8.0%
73.4%
36.1%
12.5%
509.0
489.0
15.7
6.6
223.0
716.0
2008 2016
7.8%
8.5%
73.6%
72.7%
40.9%
42.1%
12.6%
12.0%
474.0
449.0
452.0
419.0
17.5
16.6
5.7
6.5
240.0
301.0
788.0
965.0