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Zhukova",authors:[{id:"14041",title:"Dr.",name:"Sofya",middleName:null,surname:"Zhukova",fullName:"Sofya Zhukova",slug:"sofya-zhukova"},{id:"14046",title:"Dr.",name:"Elena",middleName:null,surname:"Benderskaya",fullName:"Elena Benderskaya",slug:"elena-benderskaya"}]},{id:"13181",title:"Exploiting Inter-Sample Information and Exploring Visualization in Data Mining: from Bioinformatics to Anthropology and Aesthetics Disciplines",slug:"exploiting-inter-sample-information-and-exploring-visualization-in-data-mining-from-bioinformatics-t",signatures:"Kuan-Ming Lin and Jung-Hua Liu",authors:[{id:"14835",title:"Dr.",name:"Kuan-Ming",middleName:null,surname:"Lin",fullName:"Kuan-Ming Lin",slug:"kuan-ming-lin"},{id:"16764",title:"Prof.",name:"Jung-Hua",middleName:null,surname:"Liu",fullName:"Jung-Hua Liu",slug:"jung-hua-liu"}]},{id:"13182",title:"Data Mining Industrial Applications",slug:"data-mining-industrial-applications",signatures:"Waldemar Wójcik and Konrad Gromaszek",authors:[{id:"15208",title:"Dr.",name:"Waldemar",middleName:null,surname:"Wójcik",fullName:"Waldemar Wójcik",slug:"waldemar-wojcik"},{id:"24059",title:"Dr.Ing.",name:"Konrad",middleName:null,surname:"Gromaszek",fullName:"Konrad Gromaszek",slug:"konrad-gromaszek"}]}]}],publishedBooks:[{type:"book",id:"2746",title:"Theory and Applications for Advanced Text Mining",subtitle:null,isOpenForSubmission:!1,hash:"ed74b8719e654014932e764fe1e57816",slug:"theory-and-applications-for-advanced-text-mining",bookSignature:"Shigeaki Sakurai",coverURL:"https://cdn.intechopen.com/books/images_new/2746.jpg",editedByType:"Edited by",editors:[{id:"150787",title:"Prof.",name:"Shigeaki",surname:"Sakurai",slug:"shigeaki-sakurai",fullName:"Shigeaki Sakurai"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8141",title:"Social Media and Machine Learning",subtitle:null,isOpenForSubmission:!1,hash:"155aa6c54dc411b5d2a1498f10f9417e",slug:"social-media-and-machine-learning",bookSignature:"Alberto Cano",coverURL:"https://cdn.intechopen.com/books/images_new/8141.jpg",editedByType:"Edited by",editors:[{id:"200724",title:"Dr.",name:"Alberto",surname:"Cano",slug:"alberto-cano",fullName:"Alberto Cano"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],publishedBooksByAuthor:[{type:"book",id:"2746",title:"Theory and Applications for Advanced Text Mining",subtitle:null,isOpenForSubmission:!1,hash:"ed74b8719e654014932e764fe1e57816",slug:"theory-and-applications-for-advanced-text-mining",bookSignature:"Shigeaki Sakurai",coverURL:"https://cdn.intechopen.com/books/images_new/2746.jpg",editedByType:"Edited by",editors:[{id:"150787",title:"Prof.",name:"Shigeaki",surname:"Sakurai",slug:"shigeaki-sakurai",fullName:"Shigeaki Sakurai"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},onlineFirst:{chapter:{type:"chapter",id:"81988",title:"Complementary Health Insurance in Slovenia",doi:"10.5772/intechopen.105150",slug:"complementary-health-insurance-in-slovenia",body:'Slovenia is usually counted among the countries whose health care financing system is Bismarckian. However, the Slovenian health care financing system is »bis-eridging« and getting more and more mixed. Most of the elements that are typical for a pure Bismarckian system, namely association of rights with labor status and no government interference, are not present anymore and lots of innovative elements entered the health care insurance space in the last decades.
Relatively, the Slovenian health care system ranks well across many indicators. Life expectancy has increased in the last two decades and is equal to the EU average of 80.6 years. Health spending is lower than the EU average (US$ PPP 2283 in 2019), and from the viewpoint of the benefits package, the accessibility to health services is almost universal. Due to its complementary health insurance and universal coverage, the financial protection is high-the out-of-pocket expenditures are one of the lowest in the EU, catastrophic spending is low, and unmet needs due to costs are low. The mounting problem is long waiting lists for specialist care and lack of health care personnel, especially in primary care [1].
In the following subchapter, we will describe the basic features of the health insurance system in Slovenia but will mostly focus on the concept of complementary health insurance and its role in the Slovenian health care system. On one hand, the institution of complementary health insurance brought Slovenia in front of the Court of Justice in Luxembourg; on the other hand, it played a crucial role in the economic protection of Slovenian citizens through the economic crisis between the years 2008 and 2013. Saying that it is necessary to point out that many adjustments have been introduced to complementary health insurance to ensure equal conditions for inclusion into the scheme for all citizens regardless of their age and gender and to ensure equal accessibility to complementary health insurance for all citizens is guaranteed without risk selection. In spite of all the adjustments, the nature of complementary health insurance is still ambiguous-it is declared voluntary but is in fact compulsory. Furthermore, it is run by private insurance companies while its package of services is completely dependent on the definition of services covered by compulsory health insurance does put the private providers into a subordinate position.
According to the last available data, the public expenditures for health care in Slovenia amounted to 72.8% of THE (total health expenditures) in 2019, 69.4% being compulsory health insurance and 3.4% government expenditures. The private expenditures for health care amounted to the remaining 27.2%, from which 11.7% are out-of-pocket expenditures and the rest (15.5% of THE) are voluntary insurance schemes. The Health Care and Health Insurance Act (1992) defines more types of voluntary health insurance in Slovenia, which are as follows:
Complementary health insurance, which covers the difference between total price of the service and share of the price of this service covered by compulsory health insurance. This difference is in case of no complementary health insurance covered in a form of copayments.
Substitutive health insurance, which substitutes the coverage for services (and not more) that would otherwise be covered by the compulsory health insurance, including copayments. It is intended for persons that according to the legislation cannot be insured in the compulsory health insurance scheme. As substitutive health insurance is intended for specific population groups only that might for some reason be excluded from the compulsory health insurance – legislation in Slovenia does exclude any specific population groups, such as high-earners – therefore this type of insurance is not available.
Supplementary health insurance that covers costs of health care services that are not covered by compulsory health insurance, complementary health insurance or substitutive health insurance. They cover faster access to services or increased consumer choice.
Parallel health insurance is insurance for services that are covered by compulsory health insurance but are realized following different procedures and different conditions.
All persons who have a permanent residence in Slovenia must have compulsory health insurance in Slovenia. At the end of 2021, there were 3214 (0.15%) uninsured persons with permanent residence. Mostly, these are persons whose status is undergoing change, for example, students who finished their studies and are getting employed.
Compulsory health contributions are the largest source of income in the Slovenian health care system. Contribution rates, which are employment-based and paid from gross income, vary by group and type of employment of insured individuals. Employees pay 6.36% of their gross income, while employers pay 6.56% for illness and injury out of work plus an additional 0.53% for injuries at work and occupational diseases. The total contribution rate hence amounts to 13.45% of gross income. The contribution rates are the same for self-employed, though their contribution base is equal to the gross pension base and cannot be lower than 60% of the last-known average annual wage [2]. The contributions for the unemployed are covered by National Institute for Employment; the contributions for the pensioners are covered by Pension and Disability Insurance Institute at a 5.96% contribution rate from net pensions.
The Health Care and Health Insurance Act (1992) defines the rights to health care alongside their coverage within compulsory health insurance. The coverage ranges between 10% and 100%, depending on the services. A minimum of 90% of the cost of services is covered for organ transplantation and urgent surgeries, treatment abroad, intensive therapy, radiotherapy, dialysis, and other urgent interventions included in the basic benefits package; 80% of the cost of treatment for reduced fertility, artificial insemination, sterilisation, and abortion; specialist surgery; nonmedical care and spa treatment in continuation of hospital treatment with the exception of non-occupational injuries; dental care and orthodontics; orthopedics; hearing and other aids and appliances; 70% of the cost of medications from the positive list and for specialist, hospital and spa treatment of non–work-related injuries.
A maximum of 60% is covered for non-emergency ambulance transportation, medical and spa treatment; 50% of the cost of ophthalmological devices and adult orthodontic treatment; 25% of the cost of pharmaceuticals from the intermediate list.
The remaining shares of the services must be covered by out-of-pocket copayments. As these can reach quite high levels, 95% of the population, liable to purchase the coinsurance, is insured with complementary health insurance. Due to the high share of the population covered, complementary health insurance is by far the main type of voluntary health insurance in Slovenia and has been described as ‘compulsory’ or ‘de facto essential’ [3].
There are three companies that offer complementary health insurance in Slovenia: Vzajemna, Generali, and Triglav zdravje. The premium is a flat rate and equal for everyone. The monthly premium amounted to an average of 34 EUR in 2021.
To ensure that the companies do not offer coverage only to low-risk or healthy and young individuals, the Ministry of Health (MoH) introduced the risk-equalisation scheme in 2005. According to the scheme, contributions are reallocated among the insurance companies based on the age and gender of the insured. The aim is to equalize the portfolio structures (according to the age and gender) of the insurance companies. The funds are transferred from insurance companies with more favorable risk portfolios to insurance companies with less favorable portfolios, the intention being the equalisation of differences in risk structures.
Individuals who have taken out supplementary health insurance pay premiums to the insurance companies, who in turn pay the full costs directly to the respective health care provider. As the basic benefit package in the compulsory scheme comprises a wide range of services, there is little room for supplementary health insurance. Parallel insurance, which covers services such as faster access to medical treatment, nonmedical services in hospitals, and higher-quality materials, with providers already offering services within compulsory health insurance, gains in popularity. Since 2017, the share of other voluntary health insurance (VHI) policies has been increasing, mostly due to ever-lengthening waiting lists in the public health care system. In 2019, supplementary and parallel insurance was purchased by 26% of the population (2011: 5.6%; 2015: 18.9%); however, their premiums still represent a small share (4.55%) of all voluntary health insurance premiums.
In 2018, public expenditure on healthcare in Slovenia amounted to 5.8% of GDP (gross domestic product) [4]. Over the last 10 years (Figure 1), the evolution of public expenditure on health reflects the fluctuations related to the adoption of certain measures and the economic cycle, but during this whole period, it remained at around 6% of GDP. The same is true for total current health expenditure, which reached 7.9% of GDP in 2018, the lowest level in the last 9 years, which is also below the EU average of 8.4 % of GDP [1, 4, 5]. Existing policies have been successful in maintaining spending levels, but there have been problems with the financial performance of public health facilities, and waiting times have increased, worsening the accessibility of health services [1, 5].
Health expenditure by financing scheme, in % of GDP, 2005–2018. Source: Institute for Macroeconomic Analysis and Development, 2019 [
Expenditure on VHI amounted to 1.2% of GDP in 2018, while it increased by about 0.1–0.3% of GDP between 2009 and 2018. Total health expenditure by functions and sources of funding in Slovenia (2006-2019) is shown in Figure 2. Complementary health insurance is an additional source of funding for the health system, as much as 95% of the population is enrolled. According to the Health Care and Health Insurance Act (Article 23), most health services involve high copayments for most of the population. Only certain diseases, children, and young people under 26 years of age enrolled in school are fully covered by compulsory health insurance. The risk of copayments is hence very high [1].
Total health expenditure by functions and sources of funding, Slovenia, 2006-2019. Source: Zver HE, 2021 [
Since 1992, the share of copayments has gradually increased due to a lack of public funding, especially during the last economic crisis. The income-independent single premium is the largest weakness of complementary health insurance in the system. This means that the system is regressive, although it should be supported by income solidarity given the high risk of copayments. In 2016, for example, the annual premium was equivalent to 62% of the net monthly minimum wage, 33% of the average net wage, and 57% of the average net pension [4, 6]. The regressive nature of this source was significantly reduced in 2012 when new social legislation introduced the automatic transfer of user fees from the state budget for welfare recipients. This benefit had already been introduced in 2009, but until 2012, it was not automatically linked to eligibility for social assistance [1].
Almost every permanent resident of Slovenia is entitled to the health benefits covered by compulsory health insurance either as a contributing member or as a dependent person (e.g., children). Opting out is not possible. Permanent residence is one of the most important factors for defining entitlement to health benefits, but Articles 15–18 of the Health Care and Health Insurance Act [7] set additional conditions under which a person is compulsorily insured [1, 2, 8].
According to the available data, 2,116,739 people were compulsorily insured in 2019, representing more than 99% of the population [1, 9]. About 0.14% (3345) people were uninsured at the end of 2020 [1, 9]. Most of them were temporarily uninsured, for example, because they were waiting for their entitlement to pension or unemployment benefits to be recognised. The rest were mainly people who could not meet the formal residence requirements (e.g., undocumented migrants and ethnic minorities, such as the Roma population and homeless people). In addition, at the end of 2020, 15, 892 people had compulsory insurance but did not pay their contributions, which means that their entitlement to health services was suspended, and they could only access emergency services [1].
According to the Health Care and Health Insurance Act [7], there are 25 categories of insured persons. Each category has a different contribution rate, but contributions are mostly income-based. The first big group is employees (and their dependents), the second group includes the unemployed, other persons without a fixed income who are not registered as unemployed, pensioners, farmers, and the self-employed [1]. The National Institute for Employment pays the contributions for the unemployed; the state and/or municipalities for persons without income, prisoners, and war veterans. In addition, European regulations and bilateral agreements provide health insurance coverage for citizens from almost all EU countries. Special provisions apply to certain vulnerable groups [1, 7].
Slovenia had historical experience with copayments since they existed already in the previous political and health system, which was in force until 1990. They were introduced in the early 1980s, mostly as flat rates on top of services. As the period of 1980s was marked by very high inflation rates, such an approach resulted in copayments becoming a negligible contribution (estimated only at around 1% of THE in 1989) as well as not an important burden on the patients. Still, this experience—together with the exceptions from copayments—fed directly into the solutions proposed by the new legislation adopted in 1992 [1, 10, 11].
When the legislation was being prepared in the period 1990−1992, different solutions to copayments were discussed. Considerations were given to the following options:
Flat rate copayments, which would be levied on a wide range of health services (counter argument was that any significant inflation might reduce their impact).
Percentage-based copayments (coinsurance), which would allow for flexibility and stratification.
Introduction of exceptions—these were eventually simply copied from the previous system described above.
One of the important issues in the introduction of copayments in Slovenia, however, is the absence of capping. The latter would prevent chronic patients from incurring excessive expenditure simply due to their real health needs, related to the management of their existing conditions. In turn, this might have been also one of the contributing factors to high coverage by the CHI [1, 10, 11].
CHI gained popularity, acceptance, and advocacy with the introduction of copayments into the system in 1992 under the Health Care and Health Insurance Act [7]. However, the most important regulations chronologically presented in the market development of CHI are listed below (Table 1) [1, 10, 11]. CHI served to raise additional funds for health care in addition to the funds from the compulsory health insurance and served to diversify the sources of funding. Originally, there were two providers of CHI: HIIS, and Adriatic, a for-profit commercial provider [11, 12].
1992 | The HCHI (1992), the Health Services Act (1992), and the Pharmacies Act (1992) enable the introduction of private financing (CHI as VHI is introduced in 1993). |
1999 | The Act amending the Health Care and Health Insurance Act (HCHI, 1998) established Vzajemna as a separate legal entity, completely separated from the HIIS. |
2000 | The Insurance Act (2000) declares that CHI serves the public interest; risk equalisation is introduced. In 2003, the White Paper (2003) is published and a reform proposal by the MoH calls for the abolition of CHI, which covers copayments. |
2004 | The Insurance Act (2004) again announced the introduction of a risk equalization mechanism. However, the mechanism was not implemented, and risk-based premiums were still allowed. |
2005 | The HCHI Amendment Act (2005) introduces community-based premiums for CHI to cover the copayments, risk equalisation CHI and penalties for late joiners to CHI (for every 12 months without CHI, calculated from the month a person becomes liable for paying the copayments, the premium increases by 3%, up to a maximum of 80%). |
Adriatic Slovenica (in October 2005) and Vzajemna (in December 2005) challenge the risk equalisation scheme in the Supreme Court. Adriatic Slovenica argues that the scheme would lead to higher average premiums and that this would undermine competition as it would lead to a monopoly in the long run; Vzajemna argues that the scheme does not consider the differences in the health status of persons insured with a given company and treats the companies unequally; the court upholds the government and confirms the legality of the adopted risk equalisation scheme. | |
2006 | The HCHI Amendment Act (2005) comes into force; in response to the introduction of community rating, CHI premiums increase by 18%; a further 5% increase in premiums is attributed to rising health costs. |
In June 2006, Vzajemna complains to the EC about the following shortcomings of CHI covering user fees: (1) insurers offering CHI must be included in the compensation scheme; (2) the insurance supervisory authority must be informed of any change in the conditions of CHI; (3) any increase in these premiums must be confirmed in writing by a certified actuary and can only be made under the supervision of the appointed Authority; (4) the premiums for CHI to cover the access must be the same for all subscribers of a given insurer and the contracts must not be shorter than 1 year; (5) insurers may only terminate a CHI contract if the policyholder fails to pay the premiums; (6) the revenue generated by the CHI scheme may only be used for the implementation of this scheme; (7) half of all profits generated must be used for the implementation of the CHI scheme; (8) before an insurer enters the CHI market, it must obtain the written approval of the Minister of Health. | |
2007 | In March 2007, the EC issued an official warning regarding Slovenia\'s health insurance legislation. The government had argued that CHI, which covers the copayments, despite its voluntary nature, was an integral part of the compulsory health insurance system and therefore a matter of public interest justifying government intervention to protect the general interest. The EC rejects this and argues that complementary health insurance is not a full or partial alternative to compulsory health insurance and cannot be considered part of the compulsory social security system based on EU law. |
2011 | The legislation on CHI is not changed and the EC refers Slovenia to the ECJ. The new reform proposal of the MoH. The modernisation of the health system by 2020 envisages the abolition of copayments and the introduction of a redefined, publicly financed benefits package. |
2012 | The Public Finance Balancing Act (2012) shifts costs from compulsory to complementary insurance (from public to private sector) which leads to a 13% increase in premiums for CHI. |
The ECJ confirms that Slovenian legislation on the CHI does not fully comply with the Directives on non-life insurance. The ruling concerns, among other things, the use of profits, systematic reporting, and prior authorisation; it does not concern risk equalisation. |
Development and regulation of CHI in Slovenia, 1992–2012.
In 1993−1994, mainly large companies concluded collective agreements with CHI for their employees. After initial fears that a two-class medical system would emerge, this later became a matter of individual choice. However, it was argued that the introduction of the CHI system would put an end to unlimited entitlements and the use of the compulsory health insurance system, as consumers would have to raise additional funds [11, 12].
In 1998, the Health Care and Health Insurance Act [7] was amended in such a way that the HIIS had to separate its compulsory insurance and CHI. As a result, a new non-profit mutual insurance company, Vzajemna, was established, independent of the HIIS, which subsequently became the largest provider of CHI. Ever since CHI has been on the market, there have been clear signs of imbalances between the various CHI companies. The equity problems became apparent when CHI introduced a regressive element into the system due to its flat-rate premiums (i.e., not risk-based). At that time, premiums for CHI were not risk-based and two companies (Adriatic and Vzajemna) charged identical premiums [11, 12].
When the two commercial companies offering CHI entered the Slovenian market in 2004–2005, they launched an obvious advertising campaign for younger and healthier policyholders with risk-based premiums. CHI is regulated by the Insurance Supervisory Authority (premiums level) and the MoH (market entry, approval of initial premiums, risk equalisation procedure). It does not receive tax subsidies. The CHI market is subject to relatively strict regulation, and some argue that these rules violate EU regulations [11, 12].
In 2006, the amendment to the Health Care and Health Insurance Act 2005 [7] came into force. In response to the introduction of the Community Rating, premiums increased by 18% and by a further 5% due to rising health costs. In June 2006, Vzajemna complains to the European Commission (EC) about the shortcomings of CHI (Table 1). In 2007, the EC issued an official warning regarding Slovenia\'s health insurance legislation. The government had argued that CHI, which covers the copayments for most of the services in the basic benefit package, despite its voluntary nature, is an integral part of compulsory health insurance and a matter of public interest for the protection of the common good.
In 2011, EC took Slovenia to the European Court of Justice (ECJ) for failing to amend the CHI legislation. As a result, the MoH proposed to reform the health system by 2020 and abolish CHI with a redefined publicly funded benefits package. In 2012, the Public Finance Balancing Act was passed, resulting in a shift of costs from the public to the private sector and a 13% increase in CHI premiums to cover user fees [11]. The European Court of Justice confirms that Slovenian legislation on the CHI does not fully comply with the non-life insurance directives. The ruling concerns, among other things, the use of profits, systematic reporting, and prior authorisation; it does not concern risk equalisation [11]. After several reminders, EC decided to refer the issue of this non-life insurance (health insurance) to the ECJ, which resulted in a ruling by the ECJ declaring that the provision of CHI in Slovenia is in breach of the Non-Life Insurance Directive. No direct penalty was imposed, but the Slovenian government was ordered to put an end to the infringement and to inform EC of the decision [10].
Slovenia was hit by an economic crisis a little bit later than some EU countries, at the end of 2008, when the business orders from abroad began to decline and consequently, the unemployment started to increase. As 98% of all incomes for compulsory health insurance are represented by contributions paid from wages and other incomes by the population, these changes had a big impact on the health insurance income. To assure that compulsory health insurance can still cover all its expenditures, numerous measures had to be passed. Among these measures, CHI played an important role. Compared to 2010, in 2015 expenditure on compulsory health insurance increased by € 49.17 M or 2.3%, while expenditure on CHI increased by € 66.31 M or 16.3% (Figure 3).
Expenditures of compulsory and complementary health insurance, in M€, 2010–2015. Source: Health Insurance Institute of Slovenia, Annual report for years 2013 and 2015 [
The average annual growth rate of compulsory health insurance expenditure in this period was 0.46%, while CHI expenditure was 3.07%. The growth rate of CHI expenditure was, hence, seven times higher than the growth rate of compulsory health insurance.
Despite stricter business conditions and the same contribution rate and equal (or at least not lower) access of insured persons to health services, the HIIS must comply with the commitment of the Stability and Growth Pact adopted by the EU in 1998 and subsequently upgraded several times. The Stability and Growth Pact is a set of rules that ensure that countries in the European Union maintain sound public finances and coordinate fiscal policies. According to the rules, HIIS must ensure the balance of revenues and expenditures without borrowing. As this was simply not possible in times of economic crisis, HIIS adopted and implemented innovative measures in 2009 to ensure its stable business operation. In determining the measures, the focus was on finding reserves in the compulsory health insurance system, without compromising the access of insured persons to services and without changing the rights from compulsory health insurance. The measures were primarily aimed at lowering the prices of health services and reducing the share of the price covered by compulsory health insurance and increasing the share of the price covered by CHI for medicines, medical devices, services, sickness benefits. The changes in the coverage shares happened at two levels.
The first transfer of financial obligations from compulsory onto CHI happened when HIIS passed the Decision on determining the percentage of the value of health services provided in compulsory health insurance, on 18 July 2009, namely for a spa treatment that does not represent the continuation of hospital treatment and for medicines from the interim list. The validity of the amendment to the resolution on determining the percentage of the value of health services provided in compulsory health insurance was extended to the whole of 2010. On 15 February 2010, HIIS additionally extended the reduction of the share of services at the expense of compulsory health insurance to the field of non-emergency ambulances, spa treatment other than hospital treatment, dental prosthetic services, and eye accessories for adults.
The second package of changes was brought about by the Fiscal Balance Act (2012) with the following measures:
Reduction of the share of the value of health services covered by compulsory health insurance (from 1 January 2013 onwards), meaning the transfer of the financial burden to CHI, namely:
Around 90% of the value (instead of 95%) for organ transplants, the most demanding surgical procedures, regardless of the reason, treatment services abroad, intensive care, radiotherapy, dialysis, and other most demanding diagnostic, therapeutic and rehabilitation services,
Around 80% of the value (instead of 85%) for health services related to the provision and treatment of reduced fertility and artificial insemination, sterilisation, and abortion; specialist outpatient, hospital, and spa services as a continuation of hospital treatment, except for injuries outside work, non-medical part of care in hospital and spa within the continuation of hospital treatment, except for injuries outside work, treatment of dental and oral diseases, medical devices, and injuries outside work,
Around 70% of the value (instead of 75%) for specialist outpatient, hospital, and spa services as a continuation of hospital treatment and non-medical part of the hospital and spa care as a continuation of hospital treatment, medical devices related to the treatment of injuries outside work, medicines from the positive list.
The increase in complementary health insurance is evident also from the increase of the share of complementary health insurance expenditure in GDP between 2010 and 2015: while this share increased by 0.10 percentage points, the share of compulsory health insurance decreased by 0.22 percentage points.
CHI is purchased by more than 95% of the population liable for co-insurance, which means 73% of the population. The premiums are flat-based and regressive and cover copayments in the range between 10% and 90% of the price of the services. Due to flat-based premiums, CHI has always been criticized from the equity viewpoint. In time, many adjustments have been made to the flat-based premium, such as coverage of costs of copayments for the socially vulnerable, who cannot afford to purchase CHI. Copayments are also covered for war veterans and prisoners. As the copayments are covered at the point of the service, the inequities caused by flat-based premiums are largely tackled, except for around 5% of the population right above the income limit, which would enable them to receive social benefits. For these citizens, the insurance is out of reach and might face higher unmet needs.
Since 2006, the share of CHI in total household consumption levelled around 2.9%. In 2012, the regressive nature of CHI premiums was importantly limited, when automatic coverage of CHI claims for all socially vulnerable populations from the central budget was introduced (Figure 4).
CHI expenditure as share of total household consumption, according to income quintiles, 2008–2018. Source: Zver et al. [
Due to the widely defined basic benefits package, covered by two financial sources, the demand for additional services, that are not included in the basic benefit package, is very low. The out-of-pocket payments are, consequently, the lowest in the European region and amounted to 12% according to the last available data from 2018.
In Slovenia, a system of risk equalisation and the creation of an efficient model for the long-term sustainability of the health care financing system was prepared by the MoH and included in the law in 2005 [7, 12, 17]. Risk equalisation or compensation schemes are necessary to support community-rated health insurance and were created for the market CHI. Basically, health insurers receive credits or subsidies from a national fund or authority to compensate for the additional costs of insuring older and less healthy members. The Health Care and Health Insurance Act in Article 23 regulates the basket of health benefits for a compulsorily insured person [7], albeit very substantial, from 100% to 10% of the value of the healthcare service for most adult insured persons; payment of the difference or balance up to 100% of the value of the healthcare service is the responsibility of the insured person who received the healthcare service (also depending on the type of treatment or activity) [17]. To prevent ‘cream-skimming’, companies have been obliged to participate in risk equalisation to compensate for differences in health care costs between insurance companies [7, 12].
Quite restrictive legislation [7] stipulates that insurers are obliged to cover the costs of all publicly financed health services. Children are exempt from the copayments and therefore do not need CHI. CHI appears to be compulsory for adults, as they must pay penalties if they do not take out CHI once they become liable for the copayments. For each full year (12 months) that they do not have CHI, the penalty is 3% of the premium. The maximum penalty is 80% of the premium. [17, 18]. The uniform flat premium for all CHI-insured persons established by the Health Care and Health Insurance Act [7] is independent of gender, age, or health status. However, equality is guaranteed between the different providers of CHI and between the insured person and the insurance conditions of CHI regarding the duration and termination of CHI contracts (Table 2) [12].
Triglav zdravje | Vzajemna | Generali (Adriatic) | |
---|---|---|---|
Basic premium | € 35.55 | € 34.60* | € 34.50 |
Monthly premiums for CHI (€), April 2022.
Note: *Due to the circumstances of COVID-19, the premium CHI in December 2021 was €12.1 instead of €34.6, as Vzajemna returned €22.5 to policyholders. The average monthly CHI premium was thus €32.72 in 2021, but rose again to €34.6 in January 2022, as the other two CHI companies returned profits to shareholders in the form of dividends. Source: e-Zavarovanja, 2022 [19].
The monthly basic insurance premium for the three companies in the Slovenian market of CHI shows a sustained upward trend over the period 2006–2019, despite a slight price decrease from 2013 to 2014 (Figure 5). Between 2006 and 2013, the premium increased by €93 per insurance policy [12, 20]. Apparently, Generali and Triglav zdravje are slightly higher than Vzajemna, which could be a form of risk selection [19, 20].
Monthly premiums for CHI (€), March 2016—December 2019. Source: Data from CHI companies (authors’ own calculations).
The experience with risk equalisation shows that all three companies make regular payments to CHI, as would be appropriate given their risk profiles. However, these payments are quite small, amounting to only €12 M in 2014. This corresponds to about 3% of the total premium income [19, 20].
The simplest risk adjustment factors used to balance premium risk are based on age and gender. They are easy to collect and monitor, but they are a poor measure of expected health care costs [21]. Improving the risk equalisation formula should be a focus of government action to ensure that the market CHI functions efficiently [20].
In general, although monthly basic insurance premiums fell slightly from 2013 to 2016, they have shown a sustained upward trend in recent years. It seems that the austerity measures during the economic crisis had little impact on the price level (Figure 5). To understand the reason for the escalation of premium costs, it is useful to examine the relationship between premium income and claims costs. This helps in analysing the efficiency of CHI in financing health care. The discrepancy between revenue and claims costs shows the transaction costs of using CHI for this key role in health care financing. If this discrepancy increases, it indicates inefficiency as the same number of people is insured but with higher administrative costs. Moreover, in due course, this may undermine the affordability of CHI, especially for poorer households [20].
Figure 6 shows how claims costs increased between 2007 and 2013 and then decreased slightly in 2014 (due to lower reserve costs, partly due to government pricing policies and covered benefits). Premium income has generally increased since 2006 (with slight decreases in 2010 and 2014). The difference between premiums and claims rose sharply before the crisis, reaching a peak of €64 M in 2009. As a result of the crisis, the premiums declined slightly in 2010, while claims kept on increasing, resulting in the lowest difference between both (€34 M in 2010). In the next 4 years, the revenues from premiums kept on increasing and the difference almost reached the pre-crisis level again in 2014. Another drop in the difference between revenues and claims can be observed in 2016 and 2019, the difference was again back to €65 M. [20, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35].
Revenues and costs in the markets of CHI €, 2006-2019. Source: Slovenian Insurance Supervisory Authority, Annual Report for the years 2007–2020 [
Figure 7 shows a breakdown of the difference between premium income and non-claims expenditure, suggesting that much of this is due to actual operating costs rather than profits. However, the official profit figures may not fully reflect the difference between revenues and costs [20, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35]. However, compared to other countries that provide similar resources to CHI, transaction costs in Slovenia are very low [20]. This may not be too surprising, as Slovenian insurers do not purchase services and should therefore have lower administrative costs. There are also concerns that new solvency requirements could push up transaction costs further, although the extent is not yet fully known. Rising transaction costs should be a focus of regulation to ensure that CHI remains affordable for everyone and that the CHI market is administratively efficient [20, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35].
Profits and non-claims costs in the markets of CHI, 2006–2019. Source: Slovenian Insurance Supervisory Authority, Annual Report for the years 2007–2020 [
It should also focus on better monitoring so that the market is more transparent for regulatory authorities and consumers. In a truly competitive market, insurers would automatically correct prices downwards when their cost base is reduced. A helpful piece of regulation would be to set a minimum claims ratio so that insurers must spend a minimum share of premium income on health care costs. This would limit transaction costs and help secure affordability in the CHI market. The government should also tighten reporting requirements [20].
Although the administrative costs of CHI are low by international standards, CHI on the other hand incurs transaction costs related to insurers\' profits and administrative costs, and indirectly to the costs of government regulation. The main risk of CHI is that transaction costs will continue to increase over time, reducing the administrative efficiency and affordability of this option, especially due to the new solvency requirements [20].
An increase in the efficiency of the health care system in Slovenia had been one of the declarative goals of the introduction of the CHI. It was supposed to reduce the ‘unnecessary’ demand for health services while also raising some additional financial resources for its functioning. One of the reasons for such reasoning lies in the fact that the structure of expenditures of CHI by categories is significantly different from compulsory health insurance. Namely, around 45% of the CHI expenditures are for the reimbursement of copayments on medicines (cf. the expenditures on medicines represent only 11.7% of the expenses of HIIS [36].
One of the disadvantages of CHI, which is rarely mentioned and discussed, is the impact of CHI on the efficiency of health services provision. As discussed above, the levels of copayments differ for different services. While they amount to 10% of the price for most important services, they can amount to as much as 90% of the price for services, less important for health (such as non-urgent transportation). While HIIS as a single provider of compulsory health insurance restricts the health care providers and pays the volume of their services up to a defined plan, the private health insurers offering CHI have no such restrictions. Intuitively, the providers can hence provide an unlimited number of less important services as they are 90% covered by CHI, resulting in less efficient and less cost-effective care provision. While a study, confirming such a theory, has not been conducted yet, the logic of the idea remains.
Another disadvantage of CHI to which not enough attention has been paid is surely its stabilisation role. As discussed in other sections of this chapter, CHI had a huge stabilisation impact in an economic crisis, buffering the negative impacts of higher unemployment. Resulting in a higher premium, the CHI managed to alleviate the impact of the lower incomes and contributions to compulsory health insurance. On the other hand, this enabled the health system, HIIS, and health care providers not to implement organisational changes, cost-effective measures, or increases in efficiency. The waste in the system remained the same, the outcomes are still not discussed and measured, and necessary reforms that would put the patient in the centre of integrated care still seem non-urgent in spite of long waiting times.
As had been established with a specially commissioned analysis of the performance of the Slovenian health system in 2015 by the World Health Organization (WHO) and the European Observatory on Health Systems and Policies [37], CHI played an important role in buffering the shocks experienced by the health system in the times of austerity (the period between 2009−2010 and 2014). These shocks were reflected primarily in a rapid decline in paid contributions against compulsory health insurance as unemployment rose dramatically between the end of 2009 and the first half of 20121 [38]. In that period, the Government intervened at various levels to stabilize public finance (e.g., by reducing salaries in the public sector) but in doing so it also further reduced the contributions to health insurance. HIIS acted in two ways—partly their payments were positively affected by the reduction in salaries, but they still reduced payments to hospitals by 15% in 2 years and they shifted some expenditure to CHI. This was possible as HIIS had the authority of establishing the percentage coverage of a range of services, which attracted copayments. Such an approach reduced pressure on HIIS and introduced further ‘cost-sharing’ between HIIS and the insurance providers of CHI.
CHI has remained one of the main focuses of health policy in Slovenia since its introduction. As much as it has been praised at its introduction and as much as it has been criticized all along the way, no government so far was able to significantly modify it in either way (e.g., either abolishing it or turning it into a more extensive mixed mutual health insurance). The first serious and organized attempt had been done with the Health Reform proposal published in 2003 [39].
According to that initiative and reform, the CHI would be entirely integrated into the compulsory health insurance and would thus cease to exist. After a fierce debate and controversies within the government itself, it was not implemented. There were two more attempts, which were systematically carried out by the Government, more precisely by the MoH. The first of the two was the initiative of the MoH in 2012 to seek reconstruction of this insurance and explore the possibility of it extending its scope. A policy dialogue was organised together with the European Observatory on Health Systems and Policies (Observatory). It resulted in the conclusions of not liberalising the market of these insurance and not extending their role to additional services, for example, long-term care. Finally, in the MoH term between 2014 and 2018, the minister was focused strongly on transforming the CHI into parallel compulsory insurance, which would be stratified in contributions by the income brackets, established by the IRS. This initiative ran close to its completion, but there were significant reserves. One of the important ones was in the report commissioned by the MoH to the Observatory and WHO, where the main conclusion was that the CHI contributed to the stabilisation of health financing in the times of austerity and shortages in public funding (see also above and [40]).
Remaining at very high levels of coverage and effectively covering around 83% of the total population and around 95% of those who are obliged to pay copayments it represents an important instrument for raising additional financial resources and collecting them in a transgenerational manner. The latter is the main factor why the CHI remains an asset and not a burden for the decision- and policymakers.
Although CHI had not been envisaged as such at the very beginning of the transitional reforms in Slovenia from the old political, social, and economic system to a new one in 1990–1992, it has taken ground over the past 30 years. This development occurred despite several attempts at abolishing it or transforming it into a different conceptual framework (especially in view of the need for a system approach to long-term care insurance). It has proven to be robust, and it has served to the purpose of buffering some potential negative fallout of the economic crisis from 2009 to 2014. Furthermore, contrary to the most significant and often repeated criticism, namely, that it was a regressive type of health insurance, it has proven to have a good level of transgenerational solidarity. Flat-rate premiums were the trigger to claims of regressivity, but the fact that a healthy population of persons in their 20s and 30s paying the same premiums as those above 65 years of age clearly shows an important lever for solidarity. A very high level of coverage through the inclusion of much of the adult population in the CHI enables such a situation. The intervention with which the Government around 15 years ago protected persons, who for economic reasons cannot pay for the premiums of the CHI serves as another example of solidarity and social correction of socio-economic differences. The more covert aspects of inefficiency, namely, the structure of the provided services and delay in cost-effectiveness measures, are visible only upon a systematic understanding of the health care financing system and therefore rarely discussed and put forward. Generally, productivity is dealt with only indirectly through the pricing of reimbursement criteria set up by HIIS, which has not been updated and endorsed by the medical professional societies.
The most adverse effect of a potential abolishment of CHI would very likely be a system of uninsurable copayments, which would affect the vulnerable layers of the population in Slovenia to a much more significant degree than the flat-rate premiums, with all the introduced adjustments for socially vulnerable, do. We can conclude that amidst strong pressures for either its abolishment or its expansion, the CHI in Slovenia has proven to be an important resource for the stabilisation of health expenditure. Despite it being a private insurance as it is paid after taxes, it bears a very strong public and social component.
World Health Organization Complementary Health Insurance Ministry of Health Voluntary Health Insurance Total Health Expenditures Gross Domestic Product Health Insurance Institute of Slovenia European Court of Justice European Commission
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Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. 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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. 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She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. 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Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Bacterial Infectious Diseases",value:3,count:2},{group:"subseries",caption:"Parasitic Infectious Diseases",value:5,count:4},{group:"subseries",caption:"Viral Infectious Diseases",value:6,count:7}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:2},{group:"publicationYear",caption:"2021",value:2021,count:4},{group:"publicationYear",caption:"2020",value:2020,count:3},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:1}],authors:{paginationCount:250,paginationItems:[{id:"274452",title:"Dr.",name:"Yousif",middleName:"Mohamed",surname:"Abdallah",slug:"yousif-abdallah",fullName:"Yousif Abdallah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/274452/images/8324_n.jpg",biography:"I certainly enjoyed my experience in Radiotherapy and Nuclear Medicine, particularly it has been in different institutions and hospitals with different Medical Cultures and allocated resources. Radiotherapy and Nuclear Medicine Technology has always been my aspiration and my life. As years passed I accumulated a tremendous amount of skills and knowledge in Radiotherapy and Nuclear Medicine, Conventional Radiology, Radiation Protection, Bioinformatics Technology, PACS, Image processing, clinically and lecturing that will enable me to provide a valuable service to the community as a Researcher and Consultant in this field. My method of translating this into day to day in clinical practice is non-exhaustible and my habit of exchanging knowledge and expertise with others in those fields is the code and secret of success.",institutionString:null,institution:{name:"Majmaah University",country:{name:"Saudi Arabia"}}},{id:"313277",title:"Dr.",name:"Bartłomiej",middleName:null,surname:"Płaczek",slug:"bartlomiej-placzek",fullName:"Bartłomiej Płaczek",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/313277/images/system/313277.jpg",biography:"Bartłomiej Płaczek, MSc (2002), Ph.D. (2005), Habilitation (2016), is a professor at the University of Silesia, Institute of Computer Science, Poland, and an expert from the National Centre for Research and Development. His research interests include sensor networks, smart sensors, intelligent systems, and image processing with applications in healthcare and medicine. He is the author or co-author of more than seventy papers in peer-reviewed journals and conferences as well as the co-author of several books. He serves as a reviewer for many scientific journals, international conferences, and research foundations. Since 2010, Dr. Placzek has been a reviewer of grants and projects (including EU projects) in the field of information technologies.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"35000",title:"Prof.",name:"Ulrich H.P",middleName:"H.P.",surname:"Fischer",slug:"ulrich-h.p-fischer",fullName:"Ulrich H.P Fischer",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/35000/images/3052_n.jpg",biography:"Academic and Professional Background\nUlrich H. P. has Diploma and PhD degrees in Physics from the Free University Berlin, Germany. He has been working on research positions in the Heinrich-Hertz-Institute in Germany. Several international research projects has been performed with European partners from France, Netherlands, Norway and the UK. He is currently Professor of Communications Systems at the Harz University of Applied Sciences, Germany.\n\nPublications and Publishing\nHe has edited one book, a special interest book about ‘Optoelectronic Packaging’ (VDE, Berlin, Germany), and has published over 100 papers and is owner of several international patents for WDM over POF key elements.\n\nKey Research and Consulting Interests\nUlrich’s research activity has always been related to Spectroscopy and Optical Communications Technology. Specific current interests include the validation of complex instruments, and the application of VR technology to the development and testing of measurement systems. He has been reviewer for several publications of the Optical Society of America\\'s including Photonics Technology Letters and Applied Optics.\n\nPersonal Interests\nThese include motor cycling in a very relaxed manner and performing martial arts.",institutionString:null,institution:{name:"Charité",country:{name:"Germany"}}},{id:"341622",title:"Ph.D.",name:"Eduardo",middleName:null,surname:"Rojas Alvarez",slug:"eduardo-rojas-alvarez",fullName:"Eduardo Rojas Alvarez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/341622/images/15892_n.jpg",biography:null,institutionString:null,institution:{name:"University of Cuenca",country:{name:"Ecuador"}}},{id:"215610",title:"Prof.",name:"Muhammad",middleName:null,surname:"Sarfraz",slug:"muhammad-sarfraz",fullName:"Muhammad Sarfraz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/215610/images/system/215610.jpeg",biography:"Muhammad Sarfraz is a professor in the Department of Information Science, Kuwait University. His research interests include computer graphics, computer vision, image processing, machine learning, pattern recognition, soft computing, data science, intelligent systems, information technology, and information systems. Prof. Sarfraz has been a keynote/invited speaker on various platforms around the globe. He has advised various students for their MSc and Ph.D. theses. He has published more than 400 publications as books, journal articles, and conference papers. He is a member of various professional societies and a chair and member of the International Advisory Committees and Organizing Committees of various international conferences. Prof. Sarfraz is also an editor-in-chief and editor of various international journals.",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"32650",title:"Prof.",name:"Lukas",middleName:"Willem",surname:"Snyman",slug:"lukas-snyman",fullName:"Lukas Snyman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/32650/images/4136_n.jpg",biography:"Lukas Willem Snyman received his basic education at primary and high schools in South Africa, Eastern Cape. He enrolled at today's Nelson Metropolitan University and graduated from this university with a BSc in Physics and Mathematics, B.Sc Honors in Physics, MSc in Semiconductor Physics, and a Ph.D. in Semiconductor Physics in 1987. After his studies, he chose an academic career and devoted his energy to the teaching of physics to first, second, and third-year students. After positions as a lecturer at the University of Port Elizabeth, he accepted a position as Associate Professor at the University of Pretoria, South Africa.\r\n\r\nIn 1992, he motivates the concept of 'television and computer-based education” as means to reach large student numbers with only the best of teaching expertise and publishes an article on the concept in the SA Journal of Higher Education of 1993 (and later in 2003). The University of Pretoria subsequently approved a series of test projects on the concept with outreach to Mamelodi and Eerste Rust in 1993. In 1994, the University established a 'Unit for Telematic Education ' as a support section for multiple faculties at the University of Pretoria. In subsequent years, the concept of 'telematic education” subsequently becomes well established in academic circles in South Africa, grew in popularity, and is adopted by many universities and colleges throughout South Africa as a medium of enhancing education and training, as a method to reaching out to far out communities, and as a means to enhance study from the home environment.\r\n\r\nProfessor Snyman in subsequent years pursued research in semiconductor physics, semiconductor devices, microelectronics, and optoelectronics.\r\n\r\nIn 2000 he joined the TUT as a full professor. Here served for a period as head of the Department of Electronic Engineering. Here he makes contributions to solar energy development, microwave and optoelectronic device development, silicon photonics, as well as contributions to new mobile telecommunication systems and network planning in SA.\r\n\r\nCurrently, he teaches electronics and telecommunications at the TUT to audiences ranging from first-year students to Ph.D. level.\r\n\r\nFor his research in the field of 'Silicon Photonics” since 1990, he has published (as author and co-author) about thirty internationally reviewed articles in scientific journals, contributed to more than forty international conferences, about 25 South African provisional patents (as inventor and co-inventor), 8 PCT international patent applications until now. Of these, two USA patents applications, two European Patents, two Korean patents, and ten SA patents have been granted. A further 4 USA patents, 5 European patents, 3 Korean patents, 3 Chinese patents, and 3 Japanese patents are currently under consideration.\r\n\r\nRecently he has also published an extensive scholarly chapter in an internet open access book on 'Integrating Microphotonic Systems and MOEMS into standard Silicon CMOS Integrated circuitry”.\r\n\r\nFurthermore, Professor Snyman recently steered a new initiative at the TUT by introducing a 'Laboratory for Innovative Electronic Systems ' at the Department of Electrical Engineering. The model of this laboratory or center is to primarily combine outputs as achieved by high-level research with lower-level system development and entrepreneurship in a technical university environment. Students are allocated to projects at different levels with PhDs and Master students allocated to the generation of new knowledge and new technologies, while students at the diploma and Baccalaureus level are allocated to electronic systems development with a direct and a near application for application in industry or the commercial and public sectors in South Africa.\r\n\r\nProfessor Snyman received the WIRSAM Award of 1983 and the WIRSAM Award in 1985 in South Africa for best research papers by a young scientist at two international conferences on electron microscopy in South Africa. He subsequently received the SA Microelectronics Award for the best dissertation emanating from studies executed at a South African university in the field of Physics and Microelectronics in South Africa in 1987. In October of 2011, Professor Snyman received the prestigious Institutional Award for 'Innovator of the Year” for 2010 at the Tshwane University of Technology, South Africa. This award was based on the number of patents recognized and granted by local and international institutions as well as for his contributions concerning innovation at the TUT.",institutionString:null,institution:{name:"University of South Africa",country:{name:"South Africa"}}},{id:"317279",title:"Mr.",name:"Ali",middleName:"Usama",surname:"Syed",slug:"ali-syed",fullName:"Ali Syed",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/317279/images/16024_n.png",biography:"A creative, talented, and innovative young professional who is dedicated, well organized, and capable research fellow with two years of experience in graduate-level research, published in engineering journals and book, with related expertise in Bio-robotics, equally passionate about the aesthetics of the mechanical and electronic system, obtained expertise in the use of MS Office, MATLAB, SolidWorks, LabVIEW, Proteus, Fusion 360, having a grasp on python, C++ and assembly language, possess proven ability in acquiring research grants, previous appointments with social and educational societies with experience in administration, current affiliations with IEEE and Web of Science, a confident presenter at conferences and teacher in classrooms, able to explain complex information to audiences of all levels.",institutionString:null,institution:{name:"Air University",country:{name:"Pakistan"}}},{id:"75526",title:"Ph.D.",name:"Zihni Onur",middleName:null,surname:"Uygun",slug:"zihni-onur-uygun",fullName:"Zihni Onur Uygun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/75526/images/12_n.jpg",biography:"My undergraduate education and my Master of Science educations at Ege University and at Çanakkale Onsekiz Mart University have given me a firm foundation in Biochemistry, Analytical Chemistry, Biosensors, Bioelectronics, Physical Chemistry and Medicine. After obtaining my degree as a MSc in analytical chemistry, I started working as a research assistant in Ege University Medical Faculty in 2014. In parallel, I enrolled to the MSc program at the Department of Medical Biochemistry at Ege University to gain deeper knowledge on medical and biochemical sciences as well as clinical chemistry in 2014. In my PhD I deeply researched on biosensors and bioelectronics and finished in 2020. Now I have eleven SCI-Expanded Index published papers, 6 international book chapters, referee assignments for different SCIE journals, one international patent pending, several international awards, projects and bursaries. In parallel to my research assistant position at Ege University Medical Faculty, Department of Medical Biochemistry, in April 2016, I also founded a Start-Up Company (Denosens Biotechnology LTD) by the support of The Scientific and Technological Research Council of Turkey. Currently, I am also working as a CEO in Denosens Biotechnology. The main purposes of the company, which carries out R&D as a research center, are to develop new generation biosensors and sensors for both point-of-care diagnostics; such as glucose, lactate, cholesterol and cancer biomarker detections. My specific experimental and instrumental skills are Biochemistry, Biosensor, Analytical Chemistry, Electrochemistry, Mobile phone based point-of-care diagnostic device, POCTs and Patient interface designs, HPLC, Tandem Mass Spectrometry, Spectrophotometry, ELISA.",institutionString:null,institution:{name:"Ege University",country:{name:"Turkey"}}},{id:"267434",title:"Dr.",name:"Rohit",middleName:null,surname:"Raja",slug:"rohit-raja",fullName:"Rohit Raja",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/267434/images/system/267434.jpg",biography:"Dr. Rohit Raja received Ph.D. in Computer Science and Engineering from Dr. CVRAMAN University in 2016. His main research interest includes Face recognition and Identification, Digital Image Processing, Signal Processing, and Networking. Presently he is working as Associate Professor in IT Department, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur (CG), India. He has authored several Journal and Conference Papers. He has good Academics & Research experience in various areas of CSE and IT. He has filed and successfully published 27 Patents. He has received many time invitations to be a Guest at IEEE Conferences. He has published 100 research papers in various International/National Journals (including IEEE, Springer, etc.) and Proceedings of the reputed International/ National Conferences (including Springer and IEEE). He has been nominated to the board of editors/reviewers of many peer-reviewed and refereed Journals (including IEEE, Springer).",institutionString:"Guru Ghasidas Vishwavidyalaya",institution:{name:"Guru Ghasidas Vishwavidyalaya",country:{name:"India"}}},{id:"246502",title:"Dr.",name:"Jaya T.",middleName:"T",surname:"Varkey",slug:"jaya-t.-varkey",fullName:"Jaya T. Varkey",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/246502/images/11160_n.jpg",biography:"Jaya T. Varkey, PhD, graduated with a degree in Chemistry from Cochin University of Science and Technology, Kerala, India. She obtained a PhD in Chemistry from the School of Chemical Sciences, Mahatma Gandhi University, Kerala, India, and completed a post-doctoral fellowship at the University of Minnesota, USA. She is a research guide at Mahatma Gandhi University and Associate Professor in Chemistry, St. Teresa’s College, Kochi, Kerala, India.\nDr. Varkey received a National Young Scientist award from the Indian Science Congress (1995), a UGC Research award (2016–2018), an Indian National Science Academy (INSA) Visiting Scientist award (2018–2019), and a Best Innovative Faculty award from the All India Association for Christian Higher Education (AIACHE) (2019). She Hashas received the Sr. Mary Cecil prize for best research paper three times. She was also awarded a start-up to develop a tea bag water filter. \nDr. Varkey has published two international books and twenty-seven international journal publications. She is an editorial board member for five international journals.",institutionString:"St. Teresa’s College",institution:null},{id:"250668",title:"Dr.",name:"Ali",middleName:null,surname:"Nabipour Chakoli",slug:"ali-nabipour-chakoli",fullName:"Ali Nabipour Chakoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/250668/images/system/250668.jpg",biography:"Academic Qualification:\r\n•\tPhD in Materials Physics and Chemistry, From: Sep. 2006, to: Sep. 2010, School of Materials Science and Engineering, Harbin Institute of Technology, Thesis: Structure and Shape Memory Effect of Functionalized MWCNTs/poly (L-lactide-co-ε-caprolactone) Nanocomposites. Supervisor: Prof. Wei Cai,\r\n•\tM.Sc in Applied Physics, From: 1996, to: 1998, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Determination of Boron in Micro alloy Steels with solid state nuclear track detectors by neutron induced auto radiography, Supervisors: Dr. M. Hosseini Ashrafi and Dr. A. Hosseini.\r\n•\tB.Sc. in Applied Physics, From: 1991, to: 1996, Faculty of Physics & Nuclear Science, Amirkabir Uni. of Technology, Tehran, Iran, Thesis: Design of shielding for Am-Be neutron sources for In Vivo neutron activation analysis, Supervisor: Dr. M. Hosseini Ashrafi.\r\n\r\nResearch Experiences:\r\n1.\tNanomaterials, Carbon Nanotubes, Graphene: Synthesis, Functionalization and Characterization,\r\n2.\tMWCNTs/Polymer Composites: Fabrication and Characterization, \r\n3.\tShape Memory Polymers, Biodegradable Polymers, ORC, Collagen,\r\n4.\tMaterials Analysis and Characterizations: TEM, SEM, XPS, FT-IR, Raman, DSC, DMA, TGA, XRD, GPC, Fluoroscopy, \r\n5.\tInteraction of Radiation with Mater, Nuclear Safety and Security, NDT(RT),\r\n6.\tRadiation Detectors, Calibration (SSDL),\r\n7.\tCompleted IAEA e-learning Courses:\r\nNuclear Security (15 Modules),\r\nNuclear Safety:\r\nTSA 2: Regulatory Protection in Occupational Exposure,\r\nTips & Tricks: Radiation Protection in Radiography,\r\nSafety and Quality in Radiotherapy,\r\nCourse on Sealed Radioactive Sources,\r\nCourse on Fundamentals of Environmental Remediation,\r\nCourse on Planning for Environmental Remediation,\r\nKnowledge Management Orientation Course,\r\nFood Irradiation - Technology, Applications and Good Practices,\r\nEmployment:\r\nFrom 2010 to now: Academic staff, Nuclear Science and Technology Research Institute, Kargar Shomali, Tehran, Iran, P.O. Box: 14395-836.\r\nFrom 1997 to 2006: Expert of Materials Analysis and Characterization. Research Center of Agriculture and Medicine. Rajaeeshahr, Karaj, Iran, P. O. Box: 31585-498.",institutionString:"Atomic Energy Organization of Iran",institution:{name:"Atomic Energy Organization of Iran",country:{name:"Iran"}}},{id:"248279",title:"Dr.",name:"Monika",middleName:"Elzbieta",surname:"Machoy",slug:"monika-machoy",fullName:"Monika Machoy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248279/images/system/248279.jpeg",biography:"Monika Elżbieta Machoy, MD, graduated with distinction from the Faculty of Medicine and Dentistry at the Pomeranian Medical University in 2009, defended her PhD thesis with summa cum laude in 2016 and is currently employed as a researcher at the Department of Orthodontics of the Pomeranian Medical University. She expanded her professional knowledge during a one-year scholarship program at the Ernst Moritz Arndt University in Greifswald, Germany and during a three-year internship at the Technical University in Dresden, Germany. She has been a speaker at numerous orthodontic conferences, among others, American Association of Orthodontics, European Orthodontic Symposium and numerous conferences of the Polish Orthodontic Society. She conducts research focusing on the effect of orthodontic treatment on dental and periodontal tissues and the causes of pain in orthodontic patients.",institutionString:"Pomeranian Medical University",institution:{name:"Pomeranian Medical University",country:{name:"Poland"}}},{id:"252743",title:"Prof.",name:"Aswini",middleName:"Kumar",surname:"Kar",slug:"aswini-kar",fullName:"Aswini Kar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/252743/images/10381_n.jpg",biography:"uploaded in cv",institutionString:null,institution:{name:"KIIT University",country:{name:"India"}}},{id:"204256",title:"Dr.",name:"Anil",middleName:"Kumar",surname:"Kumar Sahu",slug:"anil-kumar-sahu",fullName:"Anil Kumar Sahu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204256/images/14201_n.jpg",biography:"I have nearly 11 years of research and teaching experience. I have done my master degree from University Institute of Pharmacy, Pt. Ravi Shankar Shukla University, Raipur, Chhattisgarh India. I have published 16 review and research articles in international and national journals and published 4 chapters in IntechOpen, the world’s leading publisher of Open access books. I have presented many papers at national and international conferences. I have received research award from Indian Drug Manufacturers Association in year 2015. My research interest extends from novel lymphatic drug delivery systems, oral delivery system for herbal bioactive to formulation optimization.",institutionString:null,institution:{name:"Chhattisgarh Swami Vivekanand Technical University",country:{name:"India"}}},{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:{name:"University of Silesia",country:{name:"Poland"}}},{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. He is currently an Assistant Professor with the University of British Colombia, Canada.",institutionString:"University of British Columbia",institution:{name:"University of British Columbia",country:{name:"Canada"}}},{id:"254463",title:"Prof.",name:"Haisheng",middleName:null,surname:"Yang",slug:"haisheng-yang",fullName:"Haisheng Yang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/254463/images/system/254463.jpeg",biography:"Haisheng Yang, Ph.D., Professor and Director of the Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology. He received his Ph.D. degree in Mechanics/Biomechanics from Harbin Institute of Technology (jointly with University of California, Berkeley). Afterwards, he worked as a Postdoctoral Research Associate in the Purdue Musculoskeletal Biology and Mechanics Lab at the Department of Basic Medical Sciences, Purdue University, USA. He also conducted research in the Research Centre of Shriners Hospitals for Children-Canada at McGill University, Canada. Dr. Yang has over 10 years research experience in orthopaedic biomechanics and mechanobiology of bone adaptation and regeneration. He earned an award from Beijing Overseas Talents Aggregation program in 2017 and serves as Beijing Distinguished Professor.",institutionString:null,institution:{name:"Beijing University of Technology",country:{name:"China"}}},{id:"89721",title:"Dr.",name:"Mehmet",middleName:"Cuneyt",surname:"Ozmen",slug:"mehmet-ozmen",fullName:"Mehmet Ozmen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/89721/images/7289_n.jpg",biography:null,institutionString:null,institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"265335",title:"Mr.",name:"Stefan",middleName:"Radnev",surname:"Stefanov",slug:"stefan-stefanov",fullName:"Stefan Stefanov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/265335/images/7562_n.jpg",biography:null,institutionString:null,institution:{name:"Medical University Plovdiv",country:{name:"Bulgaria"}}},{id:"242893",title:"Ph.D. Student",name:"Joaquim",middleName:null,surname:"De Moura",slug:"joaquim-de-moura",fullName:"Joaquim De Moura",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/242893/images/7133_n.jpg",biography:"Joaquim de Moura received his degree in Computer Engineering in 2014 from the University of A Coruña (Spain). In 2016, he received his M.Sc degree in Computer Engineering from the same university. He is currently pursuing his Ph.D degree in Computer Science in a collaborative project between ophthalmology centers in Galicia and the University of A Coruña. His research interests include computer vision, machine learning algorithms and analysis and medical imaging processing of various kinds.",institutionString:null,institution:{name:"University of A Coruña",country:{name:"Spain"}}},{id:"294334",title:"B.Sc.",name:"Marc",middleName:null,surname:"Bruggeman",slug:"marc-bruggeman",fullName:"Marc Bruggeman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/294334/images/8242_n.jpg",biography:"Chemical engineer graduate, with a passion for material science and specific interest in polymers - their near infinite applications intrigue me. \n\nI plan to continue my scientific career in the field of polymeric biomaterials as I am fascinated by intelligent, bioactive and biomimetic materials for use in both consumer and medical applications.",institutionString:null,institution:null},{id:"255757",title:"Dr.",name:"Igor",middleName:"Victorovich",surname:"Lakhno",slug:"igor-lakhno",fullName:"Igor Lakhno",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255757/images/system/255757.jpg",biography:"Igor Victorovich Lakhno was born in 1971 in Kharkiv (Ukraine). \nMD – 1994, Kharkiv National Medical Univesity.\nOb&Gyn; – 1997, master courses in Kharkiv Medical Academy of Postgraduate Education.\nPh.D. – 1999, Kharkiv National Medical Univesity.\nDSC – 2019, PL Shupik National Academy of Postgraduate Education \nProfessor – 2021, Department of Obstetrics and Gynecology of VN Karazin Kharkiv National University\nHead of Department – 2021, Department of Perinatology, Obstetrics and gynecology of Kharkiv Medical Academy of Postgraduate Education\nIgor Lakhno has been graduated from international training courses on reproductive medicine and family planning held at Debrecen University (Hungary) in 1997. Since 1998 Lakhno Igor has worked as an associate professor in the department of obstetrics and gynecology of VN Karazin National University and an associate professor of the perinatology, obstetrics, and gynecology department of Kharkiv Medical Academy of Postgraduate Education. Since June 2019 he’s been a professor in the department of obstetrics and gynecology of VN Karazin National University and a professor of the perinatology, obstetrics, and gynecology department. He’s affiliated with Kharkiv Medical Academy of Postgraduate Education as a Head of Department from November 2021. Igor Lakhno has participated in several international projects on fetal non-invasive electrocardiography (with Dr. J. A. Behar (Technion), Prof. D. Hoyer (Jena University), and José Alejandro Díaz Méndez (National Institute of Astrophysics, Optics, and Electronics, Mexico). He’s an author of about 200 printed works and there are 31 of them in Scopus or Web of Science databases. Igor Lakhno is a member of the Editorial Board of Reproductive Health of Woman, Emergency Medicine, and Technology Transfer Innovative Solutions in Medicine (Estonia). He is a medical Editor of “Z turbotoyu pro zhinku”. Igor Lakhno is a reviewer of the Journal of Obstetrics and Gynaecology (Taylor and Francis), British Journal of Obstetrics and Gynecology (Wiley), Informatics in Medicine Unlocked (Elsevier), The Journal of Obstetrics and Gynecology Research (Wiley), Endocrine, Metabolic & Immune Disorders-Drug Targets (Bentham Open), The Open Biomedical Engineering Journal (Bentham Open), etc. He’s defended a dissertation for a DSc degree “Pre-eclampsia: prediction, prevention, and treatment”. Three years ago Igor Lakhno has participated in a training course on innovative technologies in medical education at Lublin Medical University (Poland). Lakhno Igor has participated as a speaker in several international conferences and congresses (International Conference on Biological Oscillations April 10th-14th 2016, Lancaster, UK, The 9th conference of the European Study Group on Cardiovascular Oscillations). His main scientific interests: are obstetrics, women’s health, fetal medicine, and cardiovascular medicine. \nIgor Lakhno is a consultant at Kharkiv municipal perinatal center. He’s graduated from training courses on endoscopy in gynecology. He has 28 years of practical experience in the field.",institutionString:null,institution:null},{id:"244950",title:"Dr.",name:"Salvatore",middleName:null,surname:"Di Lauro",slug:"salvatore-di-lauro",fullName:"Salvatore Di Lauro",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0030O00002bSF1HQAW/ProfilePicture%202021-12-20%2014%3A54%3A14.482",biography:"Name:\n\tSALVATORE DI LAURO\nAddress:\n\tHospital Clínico Universitario Valladolid\nAvda Ramón y Cajal 3\n47005, Valladolid\nSpain\nPhone number: \nFax\nE-mail:\n\t+34 983420000 ext 292\n+34 983420084\nsadilauro@live.it\nDate and place of Birth:\nID Number\nMedical Licence \nLanguages\t09-05-1985. Villaricca (Italy)\n\nY1281863H\n474707061\nItalian (native language)\nSpanish (read, written, spoken)\nEnglish (read, written, spoken)\nPortuguese (read, spoken)\nFrench (read)\n\t\t\nCurrent position (title and company)\tDate (Year)\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. Private practise.\t2017-today\n\n2019-today\n\t\n\t\nEducation (High school, university and postgraduate training > 3 months)\tDate (Year)\nDegree in Medicine and Surgery. University of Neaples 'Federico II”\nResident in Opthalmology. Hospital Clinico Universitario Valladolid\nMaster in Vitreo-Retina. IOBA. University of Valladolid\nFellow of the European Board of Ophthalmology. Paris\nMaster in Research in Ophthalmology. University of Valladolid\t2003-2009\n2012-2016\n2016-2017\n2016\n2012-2013\n\t\nEmployments (company and positions)\tDate (Year)\nResident in Ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl.\nFellow in Vitreo-Retina. IOBA. University of Valladolid\nVitreo-Retinal consultant in ophthalmology. Hospital Clinico Universitario Valladolid. Sacyl. National Health System.\nVitreo-Retinal consultant in ophthalmology. Instituto Oftalmologico Recoletas. Red Hospitalaria Recoletas. \n\t2012-2016\n2016-2017\n2017-today\n\n2019-Today\n\n\n\t\nClinical Research Experience (tasks and role)\tDate (Year)\nAssociated investigator\n\n' FIS PI20/00740: DESARROLLO DE UNA CALCULADORA DE RIESGO DE\nAPARICION DE RETINOPATIA DIABETICA BASADA EN TECNICAS DE IMAGEN MULTIMODAL EN PACIENTES DIABETICOS TIPO 1. Grant by: Ministerio de Ciencia e Innovacion \n\n' (BIO/VA23/14) Estudio clínico multicéntrico y prospectivo para validar dos\nbiomarcadores ubicados en los genes p53 y MDM2 en la predicción de los resultados funcionales de la cirugía del desprendimiento de retina regmatógeno. Grant by: Gerencia Regional de Salud de la Junta de Castilla y León.\n' Estudio multicéntrico, aleatorizado, con enmascaramiento doble, en 2 grupos\nparalelos y de 52 semanas de duración para comparar la eficacia, seguridad e inmunogenicidad de SOK583A1 respecto a Eylea® en pacientes con degeneración macular neovascular asociada a la edad' (CSOK583A12301; N.EUDRA: 2019-004838-41; FASE III). Grant by Hexal AG\n\n' Estudio de fase III, aleatorizado, doble ciego, con grupos paralelos, multicéntrico para comparar la eficacia y la seguridad de QL1205 frente a Lucentis® en pacientes con degeneración macular neovascular asociada a la edad. (EUDRACT: 2018-004486-13). Grant by Qilu Pharmaceutical Co\n\n' Estudio NEUTON: Ensayo clinico en fase IV para evaluar la eficacia de aflibercept en pacientes Naive con Edema MacUlar secundario a Oclusion de Vena CenTral de la Retina (OVCR) en regimen de tratamientO iNdividualizado Treat and Extend (TAE)”, (2014-000975-21). Grant by Fundacion Retinaplus\n\n' Evaluación de la seguridad y bioactividad de anillos de tensión capsular en conejo. Proyecto Procusens. Grant by AJL, S.A.\n\n'Estudio epidemiológico, prospectivo, multicéntrico y abierto\\npara valorar la frecuencia de la conjuntivitis adenovírica diagnosticada mediante el test AdenoPlus®\\nTest en pacientes enfermos de conjuntivitis aguda”\\n. National, multicenter study. Grant by: NICOX.\n\nEuropean multicentric trial: 'Evaluation of clinical outcomes following the use of Systane Hydration in patients with dry eye”. Study Phase 4. Grant by: Alcon Labs'\n\nVLPs Injection and Activation in a Rabbit Model of Uveal Melanoma. Grant by Aura Bioscience\n\nUpdating and characterization of a rabbit model of uveal melanoma. Grant by Aura Bioscience\n\nEnsayo clínico en fase IV para evaluar las variantes genéticas de la vía del VEGF como biomarcadores de eficacia del tratamiento con aflibercept en pacientes con degeneración macular asociada a la edad (DMAE) neovascular. Estudio BIOIMAGE. IMO-AFLI-2013-01\n\nEstudio In-Eye:Ensayo clínico en fase IV, abierto, aleatorizado, de 2 brazos,\nmulticçentrico y de 12 meses de duración, para evaluar la eficacia y seguridad de un régimen de PRN flexible individualizado de 'esperar y extender' versus un régimen PRN según criterios de estabilización mediante evaluaciones mensuales de inyecciones intravítreas de ranibizumab 0,5 mg en pacientes naive con neovascularización coriodea secunaria a la degeneración macular relacionada con la edad. CP: CRFB002AES03T\n\nTREND: Estudio Fase IIIb multicéntrico, randomizado, de 12 meses de\nseguimiento con evaluador de la agudeza visual enmascarado, para evaluar la eficacia y la seguridad de ranibizumab 0.5mg en un régimen de tratar y extender comparado con un régimen mensual, en pacientes con degeneración macular neovascular asociada a la edad. CP: CRFB002A2411 Código Eudra CT:\n2013-002626-23\n\n\n\nPublications\t\n\n2021\n\n\n\n\n2015\n\n\n\n\n2021\n\n\n\n\n\n2021\n\n\n\n\n2015\n\n\n\n\n2015\n\n\n2014\n\n\n\n\n2015-16\n\n\n\n2015\n\n\n2014\n\n\n2014\n\n\n\n\n2014\n\n\n\n\n\n\n\n2014\n\nJose Carlos Pastor; Jimena Rojas; Salvador Pastor-Idoate; Salvatore Di Lauro; Lucia Gonzalez-Buendia; Santiago Delgado-Tirado. Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical\nconsequences. Progress in Retinal and Eye Research. 51, pp. 125 - 155. 03/2016. DOI: 10.1016/j.preteyeres.2015.07.005\n\n\nLabrador-Velandia S; Alonso-Alonso ML; Di Lauro S; García-Gutierrez MT; Srivastava GK; Pastor JC; Fernandez-Bueno I. Mesenchymal stem cells provide paracrine neuroprotective resources that delay degeneration of co-cultured organotypic neuroretinal cultures.Experimental Eye Research. 185, 17/05/2019. DOI: 10.1016/j.exer.2019.05.011\n\nSalvatore Di Lauro; Maria Teresa Garcia Gutierrez; Ivan Fernandez Bueno. Quantification of pigment epithelium-derived factor (PEDF) in an ex vivo coculture of retinal pigment epithelium cells and neuroretina.\nJournal of Allbiosolution. 2019. ISSN 2605-3535\n\nSonia Labrador Velandia; Salvatore Di Lauro; Alonso-Alonso ML; Tabera Bartolomé S; Srivastava GK; Pastor JC; Fernandez-Bueno I. Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefe's archive for clinical and experimental ophthalmology. 256 - 1, pp. 125 - 134. 01/2018. DOI: 10.1007/s00417-017-3842-3\n\n\nSalvatore Di Lauro, David Rodriguez-Crespo, Manuel J Gayoso, Maria T Garcia-Gutierrez, J Carlos Pastor, Girish K Srivastava, Ivan Fernandez-Bueno. A novel coculture model of porcine central neuroretina explants and retinal pigment epithelium cells. Molecular Vision. 2016 - 22, pp. 243 - 253. 01/2016.\n\nSalvatore Di Lauro. Classifications for Proliferative Vitreoretinopathy ({PVR}): An Analysis of Their Use in Publications over the Last 15 Years. Journal of Ophthalmology. 2016, pp. 1 - 6. 01/2016. DOI: 10.1155/2016/7807596\n\nSalvatore Di Lauro; Rosa Maria Coco; Rosa Maria Sanabria; Enrique Rodriguez de la Rua; Jose Carlos Pastor. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. Journal of Ophthalmology. 2015:821864, 2015. DOI: 10.1155/2015/821864\n\nIvan Fernandez-Bueno; Salvatore Di Lauro; Ivan Alvarez; Jose Carlos Lopez; Maria Teresa Garcia-Gutierrez; Itziar Fernandez; Eva Larra; Jose Carlos Pastor. Safety and Biocompatibility of a New High-Density Polyethylene-Based\nSpherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits. Journal of Ophthalmology. 2015:904096, 2015. DOI: 10.1155/2015/904096\n\nPastor JC; Pastor-Idoate S; Rodríguez-Hernandez I; Rojas J; Fernandez I; Gonzalez-Buendia L; Di Lauro S; Gonzalez-Sarmiento R. Genetics of PVR and RD. Ophthalmologica. 232 - Suppl 1, pp. 28 - 29. 2014\n\nRodriguez-Crespo D; Di Lauro S; Singh AK; Garcia-Gutierrez MT; Garrosa M; Pastor JC; Fernandez-Bueno I; Srivastava GK. Triple-layered mixed co-culture model of RPE cells with neuroretina for evaluating the neuroprotective effects of adipose-MSCs. Cell Tissue Res. 358 - 3, pp. 705 - 716. 2014.\nDOI: 10.1007/s00441-014-1987-5\n\nCarlo De Werra; Salvatore Condurro; Salvatore Tramontano; Mario Perone; Ivana Donzelli; Salvatore Di Lauro; Massimo Di Giuseppe; Rosa Di Micco; Annalisa Pascariello; Antonio Pastore; Giorgio Diamantis; Giuseppe Galloro. Hydatid disease of the liver: thirty years of surgical experience.Chirurgia italiana. 59 - 5, pp. 611 - 636.\n(Italia): 2007. ISSN 0009-4773\n\nChapters in books\n\t\n' Salvador Pastor Idoate; Salvatore Di Lauro; Jose Carlos Pastor Jimeno. PVR: Pathogenesis, Histopathology and Classification. Proliferative Vitreoretinopathy with Small Gauge Vitrectomy. Springer, 2018. ISBN 978-3-319-78445-8\nDOI: 10.1007/978-3-319-78446-5_2. \n\n' Salvatore Di Lauro; Maria Isabel Lopez Galvez. Quistes vítreos en una mujer joven. Problemas diagnósticos en patología retinocoroidea. Sociedad Española de Retina-Vitreo. 2018.\n\n' Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor Jimeno. iOCT in PVR management. OCT Applications in Opthalmology. pp. 1 - 8. INTECH, 2018. DOI: 10.5772/intechopen.78774.\n\n' Rosa Coco Martin; Salvatore Di Lauro; Salvador Pastor Idoate; Jose Carlos Pastor. amponadores, manipuladores y tinciones en la cirugía del traumatismo ocular.Trauma Ocular. Ponencia de la SEO 2018..\n\n' LOPEZ GALVEZ; DI LAURO; CRESPO. OCT angiografia y complicaciones retinianas de la diabetes. PONENCIA SEO 2021, CAPITULO 20. (España): 2021.\n\n' Múltiples desprendimientos neurosensoriales bilaterales en paciente joven. Enfermedades Degenerativas De Retina Y Coroides. SERV 04/2016. \n' González-Buendía L; Di Lauro S; Pastor-Idoate S; Pastor Jimeno JC. Vitreorretinopatía proliferante (VRP) e inflamación: LA INFLAMACIÓN in «INMUNOMODULADORES Y ANTIINFLAMATORIOS: MÁS ALLÁ DE LOS CORTICOIDES. RELACION DE PONENCIAS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGIA. 10/2014.",institutionString:null,institution:null},{id:"243698",title:"Dr.",name:"Xiaogang",middleName:null,surname:"Wang",slug:"xiaogang-wang",fullName:"Xiaogang Wang",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243698/images/system/243698.png",biography:"Dr. Xiaogang Wang, a faculty member of Shanxi Eye Hospital specializing in the treatment of cataract and retinal disease and a tutor for postgraduate students of Shanxi Medical University, worked in the COOL Lab as an international visiting scholar under the supervision of Dr. David Huang and Yali Jia from October 2012 through November 2013. Dr. Wang earned an MD from Shanxi Medical University and a Ph.D. from Shanghai Jiao Tong University. Dr. Wang was awarded two research project grants focused on multimodal optical coherence tomography imaging and deep learning in cataract and retinal disease, from the National Natural Science Foundation of China. He has published around 30 peer-reviewed journal papers and four book chapters and co-edited one book.",institutionString:null,institution:null},{id:"7227",title:"Dr.",name:"Hiroaki",middleName:null,surname:"Matsui",slug:"hiroaki-matsui",fullName:"Hiroaki Matsui",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Tokyo",country:{name:"Japan"}}},{id:"312999",title:"Dr.",name:"Bernard O.",middleName:null,surname:"Asimeng",slug:"bernard-o.-asimeng",fullName:"Bernard O. 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We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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