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Bešič Loredan: Achieving changes in healthcare is much more difficult than expected



Minister’s conversation with the Slovenian Press Agency

The healthcare system wants to deal more with itself than with patients, there is a lot of shifting of responsibilities, assessed Health Minister Danijel Bešič Loredan. This is also why he wants to carry out a comprehensive reform of Slovenian healthcare and professionalize the councils of institutes.

After about four months of managing the health department Danijel Bešič Loredan estimates that the work is much more difficult than expected, mainly due to pressure from various interest groups. “Everyone sees only themselves and everyone would like a solution right away; why they weren’t so aggressive before, they don’t say. From this point of view, it’s more difficult (…). I have the same rules and criteria for everyone, and since I’m not biased, it’s probably even more difficult ,” he estimated.

He believes that despite his bad experience working in a public health institution, he is still an advocate of strong and successful public health institutions. “I want to change the operation of the public health system so that what happened to me will not happen to any doctor or other health care workers – that I wanted to treat, but I was fired because of that or I was banned from work and I was removed from the work process,” he said.

Above all, he wishes that employees in the health care system would do their job well and that the public health system would enable all employees to be rewarded appropriately and equally. He is convinced that this is possible, and when the system is regulated in this way, he is ready to work again in one of the public health institutions.

This minister also wants to reduce waiting times

One of the most pressing and long-standing problems is long waiting times. Shortening them is one of the government’s priorities, and the minister announced shortly after taking office that on September 15 we could have real data on waiting lists, which appear to be managed with many shortcomings. But as he admits, the aforementioned deadline was set too optimistically.

“As is now evident in the communication between ZZZS, health institutions, the National Institute of Public Health and the Ministry, there are many mistakes in ordering, there is a shift in responsibility. Individual institutions have not used some of the tools they had at their disposal for years , also did not report the data. It is the responsibility of each contractor to have up-to-date lists and to follow all instructions that are clear.” was critical. He now expects “relatively good data” on waiting lists within six weeks.

Additional work in addition to the regular program, with which the ministry intends to shorten waiting times, will otherwise be a voluntary choice of individual contractors. Based on the response so far, according to the minister’s information, about half of them are making plans to shorten waiting lists, and they want to encourage the other half to do so.

On the basis of the healthcare intervention law adopted in July, the remuneration will be regulated in more detail by the regulations, which have not yet been adopted. According to the minister’s announcement, the rules governing remuneration at the primary health care level will be adopted by October 20 at the latest, but all institutions have already received the instructions. “We simply do not have enough quality staff at the ministry for everything that should be prepared, coordinated and accepted in an up-to-date manner, so I apologize from my side,” he repented.

How to stimulate employees

As is known, the law introduces, among other things, the remuneration of the teams of outpatient clinics of family medicine, paediatrics, gynecology and dentistry at the primary level. Dispensaries with over 1,895 headcount quotients will be awarded. Those with 2,400 payroll quotients will be entitled to the maximum amount of the award, which means that each employee will receive up to 2,000 euros in gross allowance per month.

At the same time, the intervention law also determines the remuneration of other health workers. In doing so, according to the minister, they are looking for ways to stimulate employees to work even in the afternoon under the same conditions as if they were working for private companies or concessionaires during this time. “We are very close, I expect the legislative basis to be adopted in two weeks. With this, we run a small risk that employees might work a little less in the morning, but we will detect this by closely monitoring the data and react accordingly,” predicts.

Remuneration of the additional work of employees in public health institutions was initially envisaged through enterprise contracts, and with the Ministry of Finance they are also toying with the possibility of appropriately tax-exempt overtime. At the same time, he emphasizes that such awarding will be possible from October until the end of next year. He expects the first clear data on the effectiveness of the planned shortening of queues by the end of January, and a comprehensive analysis will be made based on the effect from October to next March.

Professionalization of boards of public health institutions

The aforementioned intervention law also provides for the partial professionalization of boards of public health institutions. A call for staff will be published no later than Monday. Bešič Loredan wants experienced economists, lawyers and healthcare professionals who already have some experience in the supervision or management of public healthcare institutions or other legal entities. When asked how many of the current representatives of the government in the council of institutes do not meet the listed conditions, he answered that about half.

They are looking for people who would be willing to sit in up to five sacred institutes, and at the same time be employed at the Office for Control, Quality and Investments in Healthcare, in order to have a good overview of the healthcare system. He wants as many people as possible to apply for the tender, so that he can have it because of their quality and not their party affiliation “problems” by choice.

According to the intervention law, the vast majority of council members, including those proposed by the Slovenian Health Insurance Institute (ZZZS), will have to be confirmed by the government. According to him, it is a transitional period, in the long term they want a completely apolitical control of the institutes, which would be ensured through tenders by an independent agency, which would be controlled only by the Court of Auditors and not by any of the branches of government.

How to do business without losses and at the same time properly value services?

The goal is for public health institutions to operate without losses, while at the same time providing quality services for the benefit of people. “It’s actually measurable, that’s our goal,” he said.

When it comes to paying for health services, the minister says that ZZZS has certain principles or payment models somewhat outdated. Discussions are currently underway on how to modernize the payment of outpatient services. They want to stop this point-based payment and establish a system in which it will be known exactly how much each service costs in all segments of the healthcare system.

Following criticism from the ZZZS management that they currently do not have an interlocutor in the ministry, the minister and the director of the ZZZS, as well as the president of the assembly and the board of directors sat down at the joint table again in the past few days. Bešič Loredan assessed the meeting as constructive, and expects it to be so in advance as well. They agreed to meet at “targeted meetings on specific topics”, among other things on reducing absenteeism. They also agree that the referendum on the amendment to the long-term care law, which delays the date of application of the law, is unnecessary. If, at the referendum, enough people oppose the postponement, and thus, despite the shortcomings pointed out by the professional public, it should begin to be used in the new year, the ministry also has prepared “plan B and C”. He did not want to talk about the details yet.

The deficit of ZZZS is growing

Photo: BoBo Photo: accessible

The management of ZZZS also warned him about the growing financial deficit of the health fund. According to the minister, the funds for shortening the queues are guaranteed and ZZZS’s fears that this would mean additional burdens for the institution are unjustified.

On the other hand, they are also discussing the possibility of establishing a budget buffer at ZZZS, i.e. so that any losses, as with the pension fund, would be covered by the state budget.

They conclude that, despite different prospects, there is no legal basis by which the funds that remained in the accounts of private insurance companies during the years of the epidemic due to fewer medical services provided, would be transferred either to the budget or to the health fund. However, they reached a compromise that the funds will be reserved until the end of 2023 and used exclusively to finance the increased volume of services. “A silent agreement was also made with the insurance companies not to raise the premium, which they had already wanted due to higher costs,” he added.

How to cancel supplementary insurance and find 600 million euros

Photo: Reuters

In the past few days, a strategic council for the preparation of the health system reform was also officially established. “His task is to prepare three potentially good versions for the typology of the healthcare system in Slovenia,” he explained. The minister expects the first expert report by the end of the year. “This will be the basis for starting the search for consensus on which direction the reform will go,” he added.

Part of this should also be the abolition of supplementary health insurance, but before that they must find a way to secure 600 million euros. “Funds from supplementary insurance form an important part of financing the operation of the public health system,” he reminded.

How will the country cope with the potentially heavier burden of covid-19

Currently, they are finalizing the preparation of the draft law on emergency measures to contain the spread and mitigate the consequences of the covid-19 epidemic in the field of healthcare, which, according to the minister, will be submitted to the government within three weeks. It will regulate the area of ​​free testing for the coronavirus, supplements for the treatment of covid patients, the search for the coronavirus in waste water and the rules of sick leave for up to 30 days.

When asked about the usefulness of the recommendations in controlling the covid-19 epidemic, he emphasized that their observance is the responsibility of each individual. “According to the countless instructions over the last two years, on the one hand, it is necessary to understand people that they do not want this anymore, and on the other hand, it is our job to monitor the situation and react when necessary,” he said. He wears a protective mask himself where masks are necessary and necessary – in medical institutions and pharmacies, but otherwise he uses them “common sense”.

At the same time, he emphasized that he strongly supports and recommends vaccination against covid-19, he immediately got himself vaccinated three times, voluntarily and recommends vaccination with a second booster dose to everyone over 60 and individuals with a weakened immune system.

With the arrival of new vaccines against the coronavirus, the ministry announced a promotional campaign aimed at the aforementioned groups of people. Only five percent of people over the age of 60 are vaccinated with a second booster dose of vaccines. When asked what percentage they are targeting with the campaign, he answered that as high as possible. He expects health centers to monitor interest in vaccination and adjust accessibility, similar to what they did in Ljubljana.

He emphasizes that the government opposes the introduction of mandatory vaccination against covid. The vaccination program for this year, which the previous minister left in his drawer Janez Poklukar, contained some elements of mandatory vaccination against covid, Bešič Loredan estimated some time ago. The amended program for 2022 has already been adopted and does not contain these elements, he explained in an interview with the Slovenian Press Agency.

Source: Rtvslo

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