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Friday, May 24, 2024

Are we witnessing the end of public healthcare?

By: Sara Kovač (nova24tv.si)

“The government said that they have filed an amendment to the law that abolishes supplementary health insurance. Then Robert Golob said that with the proposed amendment to the law they want to freeze the prices of supplementary insurance, thereby preventing the creation of private profits by insurance companies,” said paediatrician Tina Bregant at the beginning of her commentary on the events surrounding the abolition of supplementary insurance.

“If they do not change the proposal, then they will NOT cancel the supplementary insurance, but just transfer it to ZZZS. Which is the centralisation of assets (and a kind of nationalisation of insurance companies). With this manoeuvre, they give an additional 600 million ZZZS to the government, which has already managed the collected money questionably, since it did not pay for all services or if it paid for them, these services were significantly underpaid and for several years were not adjusted even to inflation. Some services stood out due to their good payment (e.g., for the field of radiology), but the service that requires the most medical knowledge, i.e., history and clinical examination, which is the cheapest from a technical point of view and at the same time the most important for the patient, remained significantly underpaid.” said Tina Bregant.

This political manoeuvre therefore DOES NOT regulate the operation of ZZZS, which should be restructured for the benefit of the payers – patients, think about the reorganisation of work, the method of paying for services (according to the principles of quality and safety, compliance with the principles of HTA (Health Technology Assessment), relieving doctors of administrative tasks procedures that we now do instead of ZZZS and its employees, etc.).

This manoeuvre is unsustainable in the long run and will lead to budget depletion

It is true that in this way they force those few citizens who did not pay supplementary insurance to now have to do so, said Bergant. “On paper, they will also partially solve the problem of out-of-pocket payments, which also includes supplementary insurance, but – and I dare to predict this – other, additional insurance will grow, because people will not have access to services in public institutions any faster or better with this political manoeuvre. Even more – this manoeuvre is unsustainable in the long run, if work at the insurance company is not restructured at the same time and will lead to the depletion of the budget. Not to talk about the hidden burden of work and employer costs, and pensioners.”

Is it simply a matter of “let the neighbour’s cow die as well”?

If their main purpose is to prevent profits from those who have organised themselves and work differently than ZZZS – or even operate at a profit, which ZZZS obviously cannot do (or ZZZS should allocate these funds from the “profit” to the purchase of new devices, renovation of buildings etc.), then it is simply a matter of “letting the neighbour’s cow die as well”, according to Bregant. “Obviously, it is not about ZZZS being able to follow more successful insurance models, which would return taxpayers’ funds back into the system, but simply about the amateurism and populism of cancelling something that is not optimal, but somehow works, and replacing it – with a large, dysfunctional system that will only get richer. Does this regulation therefore only increase the funds on the banco menica of the state insurance fund? For what and for whom?”

Bregant said that she is in favour of abolishing supplementary insurance, but first the operation of ZZZS must be regulated, the way of work must be changed, quality and safety must be ensured, separate baskets must be created and, of course, supplementary payment must be regulated. This has so far been regulated by supplementary insurance, and the mere transfer of funds from one insurance company to another will not regulate this. Whereby this “other” insurance company has repeatedly proven itself by not paying for services.

In defence of ZZZS, however, it is necessary to point out an unpleasant fact: in Slovenia, we collect little money in absolute terms for all the services we want, which cost about the same in Europe, according to Bregant. “Unfortunately, medicine (and even more so pharmacy) does not consider the country’s GDP and the purchasing power of its inhabitants. Yes, we can still find some reserves in the organisation of work, in the more rational use of medicines, perhaps a serious discussion is also needed about medicines for rare diseases, where almost 6% of the funds are spent on 0.1% of the population, a discussion about suppliers, prices of medicines and medical devices, centralised ordering, compliance with HTA guidelines, etc. There are some reserves. Above all, it is time for amateurs in healthcare to stop learning from their mistakes, which we will all pay for.”

We are approaching the bitter end of public health care…

Obviously, playing with healthcare is not over yet. We are approaching the bitter end of public healthcare, as this swing from one extreme: privatisation of healthcare to another: centralisation and nationalisation, is only creating chaos. Chaos and anarchy, however, like to lead to plunder. They are like turbulent, muddy waters, where predatory fish catch best…


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