By: Peter Truden
Biserka Simčič is someone that is well known to the public due to the affair from 2013, when she was punished with a fine of six thousand euros for breaking into the e-mail inboxes and the hospital information system at the Novo Mesto General Hospital, in the years 2008 and 2009. We have received unofficial information from the Ministry of Health, suggesting that Simčič has continued with her practice of inspecting the e-mails of the employees. We are also revealing that the state secretary at the Ministry of Health, Tina Bergant, whom the Minister Tomaž Gantar wants to dismiss, pointed out the irregularities in the establishing of the Agency for Quality in Healthcare, and therefore became the target of Simčič’s revenge.
A few days ago, the information was made public that the Minister of Health, Tomaž Gantar, had demanded the dismissal of his state secretary, Tina Bregant, who came to the ministry from the ranks of the Junior Doctors (Mladi zdravniki). According to some media reports, the reasons for her dismissal are inappropriate communication at press conferences, the fact that she was not working together within the COVID-19 expert group, and close cooperation with the Prime Minister’s Office.
It is, of course, possible that Bregant made some mistakes at the press conferences, which may be attributable to her inexperience in media communication, as well as political inexperience. However, the other two reasons seem, to put it mildly, strange. How can her professional contribution to the management of the epidemic be measured solely by her participation in meetings and sessions or in the professional articles? And why is Minister Gantar bothered by her close cooperation with the Prime Minister’s Office? After all, the ministry is part of the government, and cooperation with the Prime Minister’s Office is something completely normal – at least for those who want to work and, above all, finally start correcting the current situation in Slovenian healthcare, of course.
Minister Gantar is really unlucky when it comes to his state secretaries. Shortly after his appointment, Andrej Možina left him, Jerneja Farkaš Lainšček left not long ago, and now he is proposing that Tina Bregant be replaced. With all these changes, it is difficult to say that the secretaries of state themselves are the only problem here. So, what is the real reason for the third secretary of state to leave the ministry?
Fight for a monopoly over the accreditations of healthcare institutions, insurance companies, and the pharmacy
First major disagreements between Bregant and Gantar supposedly began with the negotiations for an Annex to the 2020 General Agreement, which also included a proposal to set up a non-profit quality agency. According to our information, Bregant opposed the establishment of such an agency in the manner, provided for in the annex. The Ministry of Health proposed that the financing for the non-profit agency for quality, safety, standardization and evaluation of new health technologies be provided by withdrawing 0.1 percent of the funds of the healthcare programs from the providers, and 0.1 percent of the revenues of all for-profit organizations, companies, cooperatives and institutions, including the insurance and pharmaceutical companies operating in Slovenia in the field of healthcare, for the systematic implementation of all tasks related to the management of the system of quality, safety, standardization and evaluation of new health technologies. An additional source of funding for the agency would also be the state budget. All of these providers would be required to obtain accreditation from an accreditation body, accredited by The International Society for Quality in Health Care (ISQua), and an accreditation house for the certification, based on the ISO 9001 standard. If the providers of specialist hospital activities did not meet the conditions of accreditation, the recognized value of the programme of the specialist hospital activities for the calendar year 2021, would be reduced by 0.3 percent.
And then there is the next part. In Slovenia, only one company met the conditions of the accreditation agency, namely, the AACI d.o.o. company, which is already accrediting hospitals, and under the new regulation, this would also have to be done for all other healthcare institutions, including insurance companies and pharmaceutical companies operating in the field of healthcare. Annually, around 2.3 million euros should be allocated from the healthcare fund for the newly planned agency. Additional resources for these funds would, of course, be the state budget and the contractors. In total, the hospitals and all other healthcare providers would be expected to allocate a good 3 million euros for accreditations annually. Some have estimated that the Agency for Quality would get just under 6 million euros of revenue per year. The Ministry of Health also envisaged a reduction of 0.3 percent of the revenue for the “disobedient” providers, which would be an unacceptable loss for the providers, which would therefore force them to obtain the accreditation.
Bregant pointed out the irregularities related to the agency and became the target of Simčič’s revenge
Former Minister of Health from the ranks of DeSUS, Dorjan Marušič, is the founder and partial owner of the AACI. He started focusing on quality in 2003 when he was still the State Secretary to the then-Minister of Health, Dušan Keber. Biserka Simčič, an employee of Minister Gantar’s office and, according to our reliable information, his greatest confidant, is closely connected with quality in healthcare and with Marušič. During Marušič’s time at the Ministry of Health, she headed the Sector for Quality and Safety of the Healthcare System and was the head of the Accreditation Council and a member of the core group of the Quality Council. She is a leading assessor for ISO 9001: 2000 standards and a leading assessor of NIAHO and AACI standards. Marušič and Simčič also participate in the Health Development Forum (Planet GV).
The aforementioned annex to the General Agreement for 2020 would thus be an ideal opportunity to acquire an exclusive deal for Marušič’s company AACI and would also indirectly benefit Simčič. Bregant allegedly became the target of Simčič’s revenge by pointing out the irregularities surrounding the establishment of the agency. According to our information, the Health Insurance Institute of Slovenia and the Medical Chamber of Slovenia also warned that matters related to the establishment of the agency were not “clean.” They even warned that, if the agency were established in a way that was planned by the ministry, they would report the matter to the Commission for the Prevention of Corruption. However, following these warnings, the Ministry of Health changed its mind and withdrew the disputed provisions from the annex to the General Agreement for 2020.
A similar story with the same players already took place in 2012, under the then-Minister Dorjan Marušič and the then-Head of Quality and Safety in Healthcare at the Ministry of Health, Biserka Simčič, when they managed to include the mandatory accreditation in the General Agreement for the contract year 2012, along with the possible punishment by reducing the payment for medical activities, if hospitals did not carry out these accreditations. At the time, the Institute of Health Management (Inštitut za upravljanje v zdravstvu – IUZ), which is an intermediary of the Norwegian accreditation company DNV and a representative of AACI, was favoured. We searched the web for the official website of this institute in vain. However, the story is not over yet, as according to reliable information, the ministry will include its plans for the establishment of a public, non-profit, independent and autonomous institution as an independent body for the control of quality and safety in healthcare, in the React-EU project.
Simčič damaged the relations in the ministry
However, Tina Bregant is not the only one who had problems with Simčič. According to several media reports, the relations between employees at the ministry have recently gotten worse. The head of the cabinet, Rok Petravić, has been on sick leave for a long time, officially due to burnout, unofficially due to the bad conditions and Simčič’s mobbing. As we have stated already, the latter is considered to be the minister’s right-hand woman. She supposedly supervises all of the work at the ministry, and allegedly even has an overview of the minister’s e-mail, and all other official mail, addressed to the ministry, is also checked by her.
Biserka Simčič is also well known to the public due to the affair from 2013, when she was punished with a fine of six thousand euros for breaking into the e-mail inboxes and the hospital information system at the Novo Mesto General Hospital, in the years 2008 and 2009. Between 2008 and 2009, as the head of the general service of the Novo mesto hospital, she unjustifiably checked the electronic mailboxes of the hospital employees, including hospital managers. According to our unofficial information coming from the Ministry of Health, Simčič has supposedly continued the practice of inspecting employees’ e-mails. The Ministry of Health will likely lose a good expert colleague, Tina Bregant. All indications point to the fact that the minister lost all trust in her when certain interests of some individuals within the ministry were put before the interests of the patients.