HHE HOPE 2019 - Page 21

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