By: Vida Kocjan
The health care situation is catastrophically bad. Robert Golob’s government promised changes to important laws in the field of healthcare, but nothing has come of it. The government coalition (Gibanje Svoboda, SD, and Levica) does not even fulfil the commitments written in the coalition agreement. Now we are witnessing even attacks within the coalition.
Currently, we have more than 132 thousand people in the country without a personal doctor. In case of illness, they resort to emergency centres, the situation is particularly critical in the Ljubljana and Maribor emergency centres. Health Minister Danijel Bešič Loredan says that the state of emergency perfectly created interest groups in health care. Not only does he make fun of doctors, but he also makes fun of patients. At the same time, the ministry is working on the renovation of the emergency medical aid network, which has been heavily criticised by the public. If the minister’s solutions were to apply, at least 28 current emergency clinics in many places across Slovenia would be closed. It would be even more difficult for patients to see a doctor; the wait would be longer and for many it could be fatal. After the New Year, we witnessed long queues in front of the non-profit health centre, where people were waiting to be registered with a personal physician. It was learned that two doctors were enrolling a total of 2,500 new patients.
At the same time, the doctors announced a strike, even though it could have been avoided. Representatives of the Fides union revealed the non-cooperation of the government in resolving their demands. They pointed out that the main reason for the strike is the inappropriate attitude and the extremely poor and offensive communication of the government with doctors and dentists. Among other things, they demanded that the government publicly and clearly state that doctors are not responsible for the intolerable conditions in public health care, and at the same time strongly condemn any form of violence against doctors and other medical personnel and include them as bearers of medical activity through official medical organisations in the reform of a better and more accessible public health system. Minister Bešič Loredan, however, continues to act stupid.
What are the solutions?
The Minister of Health and the government did not present solutions. Last week, the Coordination of Medical Organisations advocated for long-term solutions in healthcare. Among them, they listed the preservation of standards and norms, the improvement of doctors’ salaries and the regulation of their working hours. They asserted that, despite the poor state of health care, the doctors ensure a high degree of professional treatment.
The president of the Medical Chamber of Slovenia, Bojana Beović, reminded that the situation in Slovenian healthcare is turbulent, which is the result of several decades of delays in changes to the system as well as other factors.
Part of the problem is also doctors’ salaries, the organisation of work and burdening doctors with administrative tasks.
Nevertheless, doctors provide a very high level of professionalism, but they want to work according to the European directive up to a maximum of 48 hours per week or even less. Doctors deserve rest in order to be properly rested and able to provide a high level of treatment. They emphasised that the standards and norms for doctors apply for the safety of patients.
The president of the Slovenian Medical Association, Radko Komadina, pointed out that the association, through professional councils, is the guardian of the collection of standards and norms that the profession has compiled autonomously. At the same time, he asked the Minister of Health, Danijel Bešič Loredan, to extend the deadline for comments on the draft national strategy for quality and safety in healthcare, which expires on Friday.
They want the strategy to be the foundation on which a safe health system will be built, which will continue to be comparable to European countries.
The secretary of the Professional Association of Private Doctors and Dentists of Slovenia, Igor Dovnik, said that patients must be free to choose where they will be treated, and doctors also need the freedom to choose how much and in what labour law position they will work.
“The third freedom we need, in our opinion, is the competition of insurance companies that will provide health insurance with different packages,” he added. At the same time, he emphasised that private doctors and dentists and concessionaires are part of the solution and not the problem of Slovenian healthcare.
Beović also responded to the minister’s words regarding the heavy workload of some emergency rooms across the country during the holidays, saying that emergency situations in healthcare are perfectly created by interest groups. She said that it is appropriate to ask why healthcare in Slovenia has not been reformed for so long, and the question really arises as to whether there are interest groups behind it. Komadina added that emergency centres as the primary level of health care are currently an emergency solution for many citizens in the face of problems and have become a kind of virtual health centres.
Apparently, everything is standing still at the ministry
The Minister of Health and Deputy Prime Minister Danijel Bešič Loredan (from the Gibanje Svoboda party) answered one of the parliamentary questions in the National Assembly last September that he agreed that the Act on Health Insurance and Health Care should be amended as soon as possible, in parallel with the amendment of the Act about medical activity. “These are systemic changes, we have to change these two,” he said and announced that the solutions will be ready by March 2023. They should come into effect on January 1st, 2024, “when they will also abolish supplementary health insurance”. “We are working intensively on this,” he added, announcing that at the end of 2022 they will have options to compensate for the abolition of supplementary health insurance, so that they can then implement the system change in 2024. He also announced that based on the data prepare they will prepare changes to the legislation that will make this termination possible, that they will find a way to find the 500 to 600 million euros that are collected by health insurance companies and from which medical services are then covered. Despite the announcements, nothing has been done so far.
Shifting the blame
One of the most important commitments in the coalition agreement of the Gibanje Svoboda, SD, and Levica is also the shortening of excessively long waiting times. However, a review of data from the National Institute of Public Health shows that even in this case there are no positive measures, no tangible results, Marjan Sušelj, a representative of patients’ rights in Ljubljana, told the MMC portal. Instead, Slovenian healthcare is still shaken by the affair of deleting referrals. Not only were thousands of them deleted a few weeks ago, it still happens every day that some patients miss their check-up appointments, which SDS MP Anja Bah Žibert pointed out in early January. She said that the most unacceptable thing is the minister’s shifting of blame to others, saying that it is not the ministry’s responsibility, but the service providers.
Clinics for patients without a personal physician
The Ministry of Health has prepared a list of 94 clinics for people who do not have a personal doctor of their choice and who have paid all their contributions. These were called clinics for the undetermined. Although many wonder how medical centres with already overburdened staff will be able to organise clinics for undetermined, the minister believes that many medical centres will organise such clinics without problems, as there is an interest in working in them. Retired doctors and third- and fourth-year medical specialists will also be able to treat patients in clinics for undetermined patients or patients without a selected family doctor. “Clinics for undetermined patients or patients without a selected family doctor, which will be established this month, are a difficult solution to carry out,” said Bojana Beović. Doctors, who have the full number of identified patients, are overloaded to the maximum, she explained.
The people’s voice and Keber’s 20,000 euros for consulting work
Former Minister of Health Dušan Keber is today one of the loudest representatives of the self-proclaimed Voice of the People. However, years ago, he served extensively as an advisor to the Minister of Health.
The Voice of the People also got involved in the current situation and called a patients’ strike, and in particular they demanded an apology from Minister Bešič Loredan for his statements about their alleged extremist behaviour. They stood up for their ideologue, Dušan Keber, the former Minister of Health, and then the advisor to Minister Milojka Kolar Celarc. They are generally opposed to concessionaires. At Friday’s press conference, Loredan Bešič criticised Keber for receiving 20,000 euros for 770 hours of consulting work for the preparation of the law on health care and health insurance in 2017, even though there was no product at the end. Keber denied that there was no proposal, he boasted that, among other things, there was a proposal on how to abolish supplementary health insurance. However, Keber did not support his claims with evidence.