1. 5 th EUROPEAN HEALTH FORUM GASTEIN Boris Kramberger, Health Insurance Institute of Slovenia Gastein, 26. september 2002 1 Health Insurance Institute of Slovenia Mobile Patient in the European Health Care System – the Case of Slovenia Gastein, 26. september 2002 Boris Kramberger, univ. dipl. jour. Health Insurance Institute of Slovenia Boris Kramberger, univ. dipl. jour. Health Insurance Institute of Slovenia 5 th EUROPEAN HEALTH FORUM GASTEIN

2. 5 th EUROPEAN HEALTH FORUM GASTEIN Boris Kramberger, Health Insurance Institute of Slovenia Gastein, 26. september 2002 2 Health Insurance Institute of Slovenia Europe of patients – Slovenia’s perspective 1.What kind of implication of enlargement on health care system are expected in Slovenia? 2.Will there be any bigger changes concerning the movement of patients? 3.How will Slovenia “compete” in “European health care environment”? 1.What kind of implication of enlargement on health care system are expected in Slovenia? 2.Will there be any bigger changes concerning the movement of patients? 3.How will Slovenia “compete” in “European health care environment”?

3. 5 th EUROPEAN HEALTH FORUM GASTEIN Boris Kramberger, Health Insurance Institute of Slovenia Gastein, 26. september 2002 3 Health Insurance Institute of Slovenia Enlargement and health care system in Slovenia long tradition of public health protection in Slovenia common principles (solidarity, equity, universality) diversity constant interaction long tradition of public health protection in Slovenia common principles (solidarity, equity, universality) diversity constant interaction

4. 5 th EUROPEAN HEALTH FORUM GASTEIN Boris Kramberger, Health Insurance Institute of Slovenia Gastein, 26. september 2002 4 Health Insurance Institute of Slovenia Structural reform 1992 system of social health insurance with self-administration (Austria, Germany, Netherlands, etc.) public-private mix in financing (Belgium, Ireland, France etc) public-private mix in delivery of services (privatisation) modernisation based on real economic potential of the society system of social health insurance with self-administration (Austria, Germany, Netherlands, etc.) public-private mix in financing (Belgium, Ireland, France etc) public-private mix in delivery of services (privatisation) modernisation based on real economic potential of the society

5. 5 th EUROPEAN HEALTH FORUM GASTEIN Boris Kramberger, Health Insurance Institute of Slovenia Gastein, 26. september 2002 5 Health Insurance Institute of Slovenia Current state positive trends in health status comprehensive basket of benefits disburdened pressures on public finances/new private resources for health services diversity of resources for health care better economic situation for health care providers 8,3 % of BDP (7, 1 % of BDP as public funding; 1,1 % as private funding - mainly voluntary insurance) approx. 1120 PPP $ total per capita expenditure positive trends in health status comprehensive basket of benefits disburdened pressures on public finances/new private resources for health services diversity of resources for health care better economic situation for health care providers 8,3 % of BDP (7, 1 % of BDP as public funding; 1,1 % as private funding - mainly voluntary insurance) approx. 1120 PPP $ total per capita expenditure

6. 5 th EUROPEAN HEALTH FORUM GASTEIN Boris Kramberger, Health Insurance Institute of Slovenia Gastein, 26. september 2002 6 Health Insurance Institute of Slovenia Cross-border movements - 1 Outflow of patients: long history of social coordination (bilateral agreements, regulation 1408/71, 574/72) no notable movement out of Slovenia is expected (quality operation of the system, price levels,) cultural and language factors drive Slovene patients to local doctors Professionals? Outflow of patients: long history of social coordination (bilateral agreements, regulation 1408/71, 574/72) no notable movement out of Slovenia is expected (quality operation of the system, price levels,) cultural and language factors drive Slovene patients to local doctors Professionals?

7. 5 th EUROPEAN HEALTH FORUM GASTEIN Boris Kramberger, Health Insurance Institute of Slovenia Gastein, 26. september 2002 7 Health Insurance Institute of Slovenia Cross-border movements - 2 Inflow of patients: in Slovenia there’s no formal restrictions for mobile patients no major movement in Slovenia is not expected either: - price levels, benchmarking - rational set up of health care capacities - “free” capacities only in some special activities (specialist outpatient services, rehabilitation in spas etc) private practitioners operating in market are open to all demands Professionals? Inflow of patients: in Slovenia there’s no formal restrictions for mobile patients no major movement in Slovenia is not expected either: - price levels, benchmarking - rational set up of health care capacities - “free” capacities only in some special activities (specialist outpatient services, rehabilitation in spas etc) private practitioners operating in market are open to all demands Professionals?

8. 5 th EUROPEAN HEALTH FORUM GASTEIN Boris Kramberger, Health Insurance Institute of Slovenia Gastein, 26. september 2002 8 Health Insurance Institute of Slovenia Some data Health care capacities in Slovenia, 1999: Medical doctors (including dentists) per 1,000 inhabitants 2.48 Medical nurses per 1,000 inhabitants 6.4 Pharmacists per 1,000 inhabitants0.34 Hospital beds per 1,000 inhabitants 5.8 Hospital beds for acute cases, per 1,000 inhabitants 4.8 Hospital personnel per bed 1.7 Health care capacities in Slovenia, 1999: Medical doctors (including dentists) per 1,000 inhabitants 2.48 Medical nurses per 1,000 inhabitants 6.4 Pharmacists per 1,000 inhabitants0.34 Hospital beds per 1,000 inhabitants 5.8 Hospital beds for acute cases, per 1,000 inhabitants 4.8 Hospital personnel per bed 1.7

9. 5 th EUROPEAN HEALTH FORUM GASTEIN Boris Kramberger, Health Insurance Institute of Slovenia Gastein, 26. september 2002 9 Health Insurance Institute of Slovenia Some data Average price level of:EUR open heart surgery intervention11,593 kidney transplant45,224 heart transplant49,653 liver transplant94,153 bone marrow transplant88,657 MR examination 335 dialyses 168 Average price level of:EUR open heart surgery intervention11,593 kidney transplant45,224 heart transplant49,653 liver transplant94,153 bone marrow transplant88,657 MR examination 335 dialyses 168

10. 5 th EUROPEAN HEALTH FORUM GASTEIN Boris Kramberger, Health Insurance Institute of Slovenia Gastein, 26. september 2002 10 Health Insurance Institute of Slovenia Quality Initiatives in favour of patients To improve access, shorten waiting lists, introduce competition: - initiatives for diagnostic and treatment procedures abroad in negotiation and contracting process Cross-border collaboration between border regions To improve administration To improve communication (IT and Electronic Cards) To improve access, shorten waiting lists, introduce competition: - initiatives for diagnostic and treatment procedures abroad in negotiation and contracting process Cross-border collaboration between border regions To improve administration To improve communication (IT and Electronic Cards)

11. 5 th EUROPEAN HEALTH FORUM GASTEIN Boris Kramberger, Health Insurance Institute of Slovenia Gastein, 26. september 2002 11 Health Insurance Institute of Slovenia Future challenges new cross-border projects on the bases of spare/free capacities search for new possibilities in curing rare disease bilateral agreements..closer to mobile patients (gradual standardisation of services, etc) e - administration e - information new cross-border projects on the bases of spare/free capacities search for new possibilities in curing rare disease bilateral agreements..closer to mobile patients (gradual standardisation of services, etc) e - administration e - information