Respected participants, dear friends,
I would like to greet you and to wish all the success to you and to the conference on behalf of my organization, the largest initiative of civil society in Slovenia. It has near 300,000 members or nearly half of Slovenian pensioners. Similar to other organizations of seniors in Europe we seriously strive to maintain the quality of life and healthy aging.
Nowadays the health sector in Slovenia faces a number of challenges. I’ll share with you some information about waiting periods in public health facilities and our endeavours to regulate long-term care. These are major concerns of older and poorer people and restrict their access to appropriate services and care.
Waiting periods for the first medical examination by the specialists have been known before privatization and economic crisis, but they were negligible. They stemmed more from a lack of appropriate specialists in certain fields than from other factors. In the last three years, the situation is extremely tightened. This is due to austerity measures and privatization process.
In November 2014 95,000 people waited for the first specialist medical examination. On the hypothesis that suffer mostly elderly over 65 years old, the proportion of them who ware waiting was over 22%. For the first appointment with the rheumatologist waiting period was a year and a half. According to the National Institute of Health in the RS only 23% from the whole population believe that they do not have health problems.
One of the reasons for this situation is saving money by health insurance. Institute for Health Insurance, responsible for the financing health services reduced the payments and limited the scope for all services. The number of private practices increasing but patients with low incomes such as seniors, the unemployed, workers on minimum wages, cannot benefit from this opportunity.
The Law on balancing of public finances, adopted in 2012, has limited public expenditures, stopped employment in health facilities and brought a number of other restrictive measures. Public institutions are not able to increase and improve the personnel structure.
In 2012 in Slovenia one doctor was responsible for 1685 patients. Currently in the public health sector lacks more than 500 doctors, considering the existing norms, and even more nurses. At the same time, a large number of young doctors are unemployed, waiting for practical training – stage and specialisation and for employment.. They are also leaving Slovenia to work in other countries. By the same law promotion opportunities of employees are limited. The limits have impact on the level of wages and cause les money for the budged. Sharp saving therefore has a direct impact on access to health care by our people. Even with small eliminating of measures mentioned above, this trend could be reversed.
Experts enumerate some elements that could reduce waiting time: better organization of work in health care facilities, upgrade of standards and norms, better mutual communication among doctors, better communication between institutions, “triage” patients according to the urgency of treatment, rationalization of the network of health care institutions (current emergency network), increase competitiveness, etc. The question of standards exacerbated so much in the last months, that doctors threaten with strike. One hour strike was in the meantime carried out.
People hope that the changes will bring a reform of health system, which is under preparation. At the same time they are afraid that the reform will focus on accelerating of privatization, which will lead to further differentiation. It is estimated that in this case regular access to health may be provided only for a thin layer of rich population, for the majority with low-income, however, the situation will deteriorate further.
The second challenge in Slovenia is long-term care.
The background and proposals for the content of a law, had been prepared and proposed before 2006. In 2010 the text of the law was prepared and submitted to the procedure, which is still going on.
The proportion of the elderly population is growing. Now the proportion of the 65+ age group is over 22% of the total population. According to the demographic projections, published by the Statistical Office of Slovenia, the number of people older than 65 years will increase constantly. If the growth of the population will rise similar as it was in the period from 2006 till 2013, we will have an increasing of 3.6% seniors per year.
Due to the expected demographic trends and the expected increase in the number of people who will need long-term care, this issue will not be able to present on the way and with the prevailing forms of institutional care. The pressure on long-term care will increase especially by those who live alone. In 2013 over 65,000 or more than 20 % of total population in 65 plus age group were in such a situation. In the most disadvantaged situation are older people living alone in cities and bloc settlements. We have examples of finding dead elderly in their rooms.
In long-term care are about 43,000 persons, representing 13.6% of the total population aged 65 and over. In public institutions and concessionaires there are 9.6%, at home only about 4%. The share of nursing at home increases during the last two years. However, the question arises whether this is good. People stand out from institutional care because of the price increasing. The costs are becoming too high for them and their relatives to cover. But it is not clear how much quality is in later home care.
In the future it will be necessary to increase the share of people in the home environment and in this more than ever to include relatives and other providers and to provide more incentives and payments. Such care will be established at conception mixed public-private cooperation and financing. The possibility of long-term care is the current arrangement scattered on various services and various benefits provided by health insurance systems, social security, pension and disability insurance and protection of the toughest people with disabilities, war invalids and war veterans. The new law will cover all of the above mentioned categories at the question of long term care. Due to the proposal financial resources will be provided through a new contribution from earnings and taxes. It will cause some new burdens. But it will also result in the release of part of the assets in the above-mentioned insurance systems, which are currently financing long term care.
Based on the documents of the European Commission, which provide the most important elements in the process of developing this area, we have set the following objectives:
- improve social security and the quality of live for persons who need help,
- achieve high-quality personalized service with priority to those services which offers to stay longer in home care,
- include families, professionals and volunteers in the process of home long term care,
- assure solidarity and sustainability in financing long-term care,
- systematically carry out prevention and introduce modern technology in this field.
The Federation of Pensioner Societies of Slovenia
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Jožica Puhar, BA Sociology
“Waiting periods in public health facilities, long-term care”, BERLIN, May 2nd 2015