By Gal Kovač (nova24tv.si)
Eva Irgl, Chair of the Commission on Petitions, Human Rights and Equal Opportunities, has called an urgent meeting of the Commission in view of the chaotic and dangerous situation in the healthcare sector. Among others, Minister of Health Bešič Loredna and Ljubljana Mayor Janković, who have been filling the headlines in recent days with their unusual relationships, will also be called to answer some questions at the session. A number of other healthcare stakeholders have also been invited to attend the Commission’s meeting, which will address “the violation of the legal rights and the constitutionally enshrined right to healthcare of all citizens without a general practitioner.”
Irgl explained that she had convened the Commission session “because more than 130,000 people have found themselves in dire straits, having been left without a general practitioner practically overnight, even though they pay for compulsory health insurance. This violates their constitutional right to health care and their rights under compulsory insurance. This also gives all those who have been left without a personal doctor the possibility of legal action against the state, which some lawyers have publicly pointed out already. What has been happening recently is unacceptable and must be resolved as soon as possible, in favour of the patients who pay for healthcare and the rights that come with it.”
The common cold season has revealed the depth of the disintegration of Slovenian healthcare. The festive season was first marked by a near-war situation in the emergency rooms in Maribor and Ljubljana. Immediately after the holidays, a new shock followed, when the media were flooded with images of the Ljubljana Health Centre, where patients waited in queues that stretched for hundreds of meters, in order to be examined or seen by a personal physician. At the same time, the trade union representative of Slovenian doctors and dentists, FIDES, was negotiating with the government to raise salaries and improve working conditions. This was followed by the most bizarre chapter in the history of protests organised by left-wing activists, the “patients’ strike”, in which the rally participants blamed capitalism and doctors for the tragic situation in the healthcare sector and wished the Prime Minister lots of success in his work.
However, Slovenians did not need the above-mentioned media shocks to realise that there is something very wrong with our healthcare system. This was already quite clear to all 132,000 people who are not registered with a general practitioner. It was also quite clear to all those who spent the holidays in the emergency room. There were even some cases where patients had to wait almost 48 hours to be seen by a doctor. The seriousness of the problem is also clear to those who, on hearing that they are seriously ill, are told that they will have to wait a year or even several years for a procedure or treatment. The longest waiting times are recorded for cardiology, dermatology and orthopaedic services. The current Minister of Health, Bešič Loredan, specialises in orthopaedic surgery.
Unacceptable waiting times
The National Institute of Public Health’s reports explain that waiting times depend on the level of urgency. According to the Institute’s latest monthly report on waiting times, we recorded legally unacceptable waiting times for as many as 21 health services for those with the urgency level of “regular”. One in six of those with a referral labelled as “regular” has been waiting for treatment for more than two years. When it comes to the “urgent” level of urgency, 34 percent of patients had a waiting time longer than the legal limit. And of those with the “very fast” urgency level, 48 percent had a waiting time longer than the legal limit (14 days). According to the latest data, as many as 200,000 people are currently waiting for their first examination and treatment. Unacceptably long waiting times violate patients’ rights that they have under the law. The Ljubljana Representative of Patients’ Rights commented on the situation by saying: “We know that a whole raft of measures have been taken to eliminate unacceptably long waiting times, but there are still no tangible results.”
The most acute problem is, of course, the shortage of doctors. The Mayor of Ljubljana, Zoran Janković, who is responsible for the situation in Ljubljana’s Health Care institutions, suggested that doctors should be “imported” from the former Yugoslav countries, given the acute shortage of doctors. The proposal was the subject of lots of criticism, as the core of the proposal was to change (or waive) the condition of mastering the Slovenian language for anyone who comes to work here – which could, of course, greatly compromise the quality of healthcare. At the same time, two other arguments were raised against the proposal. The first was that such “importing” of doctors is morally questionable, since every doctor leaving, for example, Bosnia and Herzegovina, causes a “hole” there, which is at least as big or worse than the one caused by a doctor’s departure from Slovenia. Questions have also been raised as to whether there would be any interest in such a thing, since the situation in the Slovenian healthcare system is not exactly great and, therefore, it is not very attractive for foreign experts.
The left has traditionally tackled this problem by fighting the doctors themselves. They are bothered by the private practices of doctors, who, in addition to fulfilling the legal quota in public healthcare institutions, also practise medicine in private practices in their spare time. The left-wing representatives call doctors who work in both the public and private healthcare systems amphibians. They would like to ban this practice and, at the same time, increase the doctors’ workload. Doctors, on the other hand, warn that such a sharp attitude would result in doctors leaving the public healthcare system. The grass is indeed greener on the other side of the fence, the workload is much lighter in the private sector and abroad, and, above all, the pay is more generous. This was also confirmed by the story recently published by the Association of Young Doctors, which we reported on in the article entitled “Direct letter from a young doctor to the Minister: ‘I hope you will stop humiliating all the other doctors who are still persisting!’”
The only long-term stable solution is to increase the number of Slovenian doctors. That is why, in the previous mandate, the Janez Janša government increased the number of enrolment places at the medical faculties in Ljubljana and Maribor. The number of places increased from 165 to 205 in Ljubljana and from 96 to 106 in Maribor. At the time, the measure was criticised mainly by the representatives from the left side of the political spectrum – on the grounds that the government was trying to penalise social science faculties. The government was convinced that Slovenia needs more natural scientists, while the left believe that the future of Slovenian intellectuals lies primarily in the social sciences.
The problem of corruption in healthcare
Corruption also represents a particular problem in the healthcare sector. According to an estimate by Blaž Mrevlje, a doctor, some 10 billion euros have been siphoned off from the healthcare sector over the last 30 years. One of the most common ways to do this is, of course, by overpaying for materials. There is probably not a single citizen left in all of Slovenia who has not heard of the “vascular stents” scandal that happened in the past. In that affair alone, 196 million euros were siphoned off from the Slovenian healthcare system, at the expense of Marc Medical, a company owned by the famous KB 1909, which entered the ownership structure of the far-left weekly magazine Mladina in 2007. The vascular stents affair was previously investigated by Jelka Godec, leader of the Slovenian Democratic Party (Slovenska demokratska stranka – SDS) group of MPs. She offered a comparison several years ago that perfectly explains the problem of overpaying for medical supplies. At that time, vascular stents cost 300 euros in Germany, 240 euros in Poland, and in our country, the purchase price stopped at a staggering 1,350 euros. “They were even being sold here in Ljubljana at a different price than in Maribor, which shows that the purchasing services do not even talk to each other. How could there be such a difference in price, and where did the money go?” Godec wondered at the time.
Janez Janša‘s government addressed this problem in the previous mandate by introducing the compulsory purchase of medical equipment at reference prices. The move was welcomed by one of the most prominent campaigners against corruption in healthcare, Marko Noč, Head of the Clinical Department of Intensive Internal Medicine at the University Medical Centre Ljubljana. The vote was largely avoided by the opposition MPs at the time, and some even rejected the law that was introduced at the time, including an MP from the Social Democrats party (Socialni demokrati – SD), two MPs from the failed List of Marjan Šarec party and the entire Left party (Levica).
Key stakeholders in the healthcare system will be present at the session
Those invited to tomorrow’s session will therefore have a lot to discuss. In addition to the Minister of Health and the Mayor of Ljubljana, Peter Svetina (the Human Rights Ombudsman), Luka Mesec (Minister of Labour, Family, Social Affairs and Equal Opportunities), Bojana Beović (President of the Slovenian Medical Chamber), Aleksander Stepanović (President of the Slovenian Family Medicine Society), Tatjana Mlakar (Director-General of the Health Insurance Institute of Slovenia – ZZZS), Tina Bregant (former State Secretary at the Ministry of Health), Marko Novak (Faculty of Law and Faculty of Government and European Studies, the New University), a representative of the Association of Young Doctors, Duša Hlade Zore (the Patients’ Rights Advocate), and a representative of the Social Institutions of Slovenia have all been invited to the session.
The meeting took place on the 16th of Januarym, 2023, at 5 p.m.