By: Vida Kocjan
The presence of Nika Kovač at the healthcare consultation will be a slap in the face to all healthcare workers. How many people will have to die because they will not receive timely diagnoses? Amid all the attacks on Slovenian healthcare professionals, Robert Golob’s government has come up with an “innovative” approach to reducing waiting times. It plans to limit the number of critical diagnostic tests.
Slovenian public healthcare has been on the verge of collapse ever since Golob’s government began its open war against doctors. Increasingly drastic measures are being introduced, which will ultimately harm only the patients, who on average pay about 350 euros per month for healthcare but end up without services. How is the Ministry of Health fighting for the monopoly of state healthcare? By limiting services.
The Ministry of Health plans to restrict the number of diagnostic tests that a single healthcare team can perform. Minister Valentina Prevolnik Rupel intends to limit the number of tests to 3,000 per team. As a result, 100,000 fewer MRI and CT scans would be performed by private contractors. MRI and CT scans are critical examinations for the early detection of cancerous changes when people still have no symptoms. Such examinations have saved thousands of lives over the past decade and have significantly increased life expectancy. But it seems that the government or the ministry does not care whether there are a thousand more or a thousand fewer of us.
A measure that will further extend waiting times for specialists
This appears to be an “innovative” approach to reducing healthcare waiting times. The fewer diagnostic tests prescribed, the shorter the waiting lines – perhaps in the hope that family doctors will not even refer patients for tests, as an MRI, which could detect early-stage cancer, will not help much if the appointment is scheduled for 2028. However, any such limitation will lengthen waiting times and worsen the overall health of the population.
Why do we have waiting lines in healthcare?
Let’s recall: the only real reason we have waiting lines in healthcare is that the Health Insurance Institute of Slovenia (ZZZS) irrationally spends the enormous sums taxpayers allocate to it every month, and then limits the number of procedures. Doctors within the public network would perform more procedures – but they are not allowed to because of capped quotas. If the ministry limits the number of examinations to 3,000 per medical team, it will further fuel the fire of waiting lines, as the ministry will be using the same methods ZZZS employs to extend waiting times.
Expert Nika Kovač?
Last week, an announcement stirred public attention: left-wing political activist Nika Kovač will give a lecture to directors and healthcare managers on November 20th at a consultation organised by the Association of Healthcare Institutions of Slovenia. The news caused considerable discontent among healthcare workers. The programme reveals that Kovač will deliver a one-hour introductory lecture titled Resilience of Public Healthcare: Why We Must Defend the Common Good. The organisers describe her as the director of the Institute March 8th. Following her lecture, there will be presentations about Slovenian healthcare yesterday, today, and tomorrow. Božidar Voljč, President of the Republic of Slovenia’s Commission for Medical Ethics and former Minister of Health, will talk about past healthcare. Milena Kramar Zupan, Director of the General Hospital of Novo mesto and a prominent member of the Social Democrats (SD) party, will speak about healthcare today. Valentina Prevolnik Rupel, the current Minister of Health, will lecture about the future of healthcare. However, there are questions about whether Prevolnik Rupel will even attend the “future” discussion.
Some sources suggest she might leave for Madrid, where her husband will take over leadership of a diplomatic mission. It raises a significant question: how can healthcare workers allow a lecture by leftist political activist Nika Kovač? Kovač has never worked a single hour in healthcare, nor does she have any medical knowledge. Moreover, her title as director of an institute seems tenuous. While she is indeed the director, this institute was established in June 2016 by the Levica party, specifically Simon Maljevac, the Minister for a Solidary Future. The institute operates out of a residential block at Glinškova ploščad 9 in Ljubljana. It is also not known whether this so-called institute employs anyone. Nevertheless, paper can bear anything.
Sharp reactions to the ruling party’s nonsense
The announcement about Nika Kovač’s planned lecture to senior healthcare workers sparked numerous sharp reactions from the public. Jelka Godec, head of the SDS parliamentary group, commented: “It is no surprise, knowing that the management listens to lectures by Nika Kovač, while the minister eagerly listens to Slovenia’s top ‘doctor,’ Jaša Jenull, and his advisor, Dušan Keber. They are shortening waiting times and addressing the problem of absenteeism.”
The Civil Initiative Young Doctors of Slovenia posted on their website: “You are doing nonsense. We know that you are doing nonsense. You know that we know that you are doing nonsense. We know that you know that we know that you are doing nonsense. And yet, you keep doing nonsense.”
Doctor Dušan Vlahović was also critical:“This clearly shows that no one at the Ministry understands the processes in healthcare. All they will achieve is to limit patients’ access to examinations, which is criminal. If the Health Insurance Institute of Slovenia (ZZZS) doubts the justification of an examination, they can verify that justification. Limiting access, however, is nonsense.”
A Healthcare Reform that is not one
The “idea” of restricting access to examinations is part of the broader strategy of Prime Minister Golob’s government to fully nationalise public healthcare, the core of which is a healthcare reform that is not a reform at all. The changes are primarily heading toward a strict separation between public and private healthcare, where “public” would essentially become synonymous with “state-run,” and the public sector would no longer be allowed to receive any assistance from the private sector. Experts in the field warn that conditions will only worsen because the reform will drive doctors into the private sector, further lengthening waiting times.
Minister’s admission: The system will be unstable
Valentina Prevolnik Rupel appeared on the show Odmevi on Slovenian national TV. She admitted that the planned changes to the Healthcare Services Act will destabilise the healthcare system. As if it were not already unstable. She provided no further clarification, merely adding that “the Ministry must do this.” She did not explain who is instructing them to take such steps, though public discourse has noted foreign praise for the current government’s strong cooperation with NGOs in healthcare. In this case, it is the initiative Voice of the People, publicly represented by “expert” Jaša Jenull, with Dušan Keber operating in the background – and occasionally Nika Kovač appearing nearby.
The Young Doctors of Slovenia noted that it has been more than six weeks since initial warnings from doctors across the country that the proposed amendment to the Healthcare Services Act would be a death blow to their departments or services. Now comes the admission that the system will be destabilised: “The problem is that patients will be left without these services. Every Slovenian citizen understands what instability means for a system that is already on the brink of collapse.” The doctors informed the Ministry they are waiting for an announcement admitting the amendment was an irreversible mistake and withdrawing it. No response has been forthcoming. At the same time, the doctors are calling on the media to hold the Minister and government accountable.
Ahčan: “People simply cannot take it anymore and leave”
Surgeon Prof. Dr Uroš Ahčan: “It seems that healthcare workers have, because of all the negative narratives – bordering on hate speech – lost much of the ethical drive that once fuelled the healthcare system. Over the last decade or two, we have worked under very disorganised and poor conditions, with bad infrastructure. But love for the profession and work, as well as the positive responses from people and patients, encouraged us to do our best. In recent years, however, it feels as if we are playing on a foreign, waterlogged field with eight players against eleven, with a referee who consistently rules against us, and spectators who constantly boo us. It all becomes distracting and painful. You lose motivation and energy, and that is why we increasingly see people making the decision that they simply cannot take it anymore and leave.”
Mag. Ivan Simič: “The war against doctors is unnecessary, the only losers will be patients”
Tax expert Mag. Ivan Simič wrote on his blog: “For the state, it seems better to do nothing than to do something and at least collect taxes from it. This is an abuse of state power, where a government body dares to threaten independent healthcare entrepreneurs, some of whom earn less monthly after taxes than members of parliament receive as their untaxed parliamentary allowances. The legislative branch passed an amendment to the Personal Income Tax Act for its €500–800 allowances, abolishing income tax and contributions on parliamentary allowances. Now, the executive branch wants to tax independent healthcare entrepreneurs who operate legally and use a legal business form provided for by the law.” He concluded that this war against doctors is unnecessary: “Based on everything mentioned above, I believe the only losers in this war will be the patients. Because as long as you are not sick, as long as you are not lying on an operating table, as long as you are not being wheeled down the clinical centre’s halls, where the ceiling lights of the old hospital are your only guide to your room, you can afford to mistreat doctors. Someone among these attackers should explain to me why this is necessary because, in the end, we all end up in the cold ground.”
Federico V. Potočnik: “Boycott is the only dignified response!”
Federico V. Potočnik, a young infectious disease doctor employed at SB Celje, stated: “The presence of Nika Kovač at the healthcare conference is a slap in the face to all healthcare professionals. She knows nothing about healthcare. And yet, she would lecture directors? Insulting. Other invitees and speakers should cancel their attendance. Boycott is the only dignified response!”
Limits on examinations and open questions
The Ministry of Health is planning to limit the number of diagnostic examinations that a single healthcare team can perform. If the limit were set at 3,000 examinations per team, as mentioned by the Minister of Health, the largest private contractors would collectively perform 100,000 fewer MRI and CT scans.
Questions awaiting answers: The waiting time to see an ophthalmologist is already between 1 and 4 years – what more could “fluctuate”? The waiting time for physiotherapy is 1.5 years – what more could “fluctuate”? The waiting time for an orthopaedist exceeds one year – what more could “fluctuate”?