Valentina Prevolnik Rupel

By Valentina Prevolnik Rupel and Dorjan Marušič

Achieving high quality in the provision of healthcare services represents a basic factor in meeting the healthcare needs of the individuals. Accessibility to health services in Slovenia over the last two decades has been presented according to some of the core values of quality and safety: performance, quality and patient-centeredness. The focus of the chapter is on three pillars of health system quality: structure, processes, and outcomes. In each part, we presented the standard practice and state of the art, but also the main achievements in the last decade. In the structural part, we highlight the investment in equipment and human resources and in the process part, the role of the primary level as a gatekeeper with the secondary and tertiary level. The results section concentrates on the measurement of the results in healthcare; the use of quality indicators and PROMs is discussed, the role of quality strategy and health technology assessment in the Slovenian healthcare system is presented.

Part of the book: Healthcare Access

By Tit Albreht, Marjeta Kuhar and Valentina Prevolnik Rupel

Almost all health care services in the Slovenian basic benefits package are paid for from two financial sources: compulsory and complementary health insurance (CHI). Although this is unusual, around 90% of the population is insured under CHI. CHI covers the costs of copayments for most of the services. One of the advantages of the CHI is that it enables the public sector to shift the costs of service onto the private sector, which can compensate for the higher costs through premiums. Its administrative costs are low, the risk selection is low due to the equalisation schemes in place, and costs of copayments for the socially weak are covered by the state budget. Out-of-pocket costs are low due to most of the population being insured in CHI. On the other hand, there are many disadvantages of this unique amphibian health system. Besides the higher complexity and costs of such a health insurance system, CHI premiums are flat and regressive. The voluntary nature of CHI is highly questionable as the copayments can be as high as 90% of the total service costs. And last, but not least, CHI removes an incentive for the providers and payer to aim for efficient services.

Part of the book: Health Insurance