Organization : Zavod za zdravstveno zavarovanje Slovenije
Type of Facility : Compulsory Health Insurance
Country: Slovenia
Website : https://www.zzzs.si/
Compulsory Health Insurance:
With the health care legislation, passed in 1992, Slovenia introduced a system of health insurance, compulsory for all the citizens of the Republic of Slovenia having their residence in the territory of Slovenia.
Related : Slovene Health Insurance Card Slovenia : www.statusin.org/9564.html
As part of the compulsory health insurance, the insured persons are guaranted by the Law the following:
** the payment of health services,
** sick pay during temporary absence from work,
** the reimbursement of travel expenses tied to obtaining health sevices.
Systems of Funding the Health Care Activities:
In different health care activities funded by the compulsory health insurance, different systems of funding apply.
In the primary health care activity (general physician surgeries, paediatrician and school children surgeries), a combined system of capitation and fee for services is in effect. The same system has been introduced in primary gynaecology. In other areas of the primary level health care in its narrow sense, the fee for service system is applied. The health education and some of the preventive programmes are funded by the Institute in the form of fixed sums.
In the specialist dispensary activity, the fee for service system is mainly in effect. For individual specialist dispensary activities, standards are specified, to determine the annual planned number of visits per team. In the dialysis activity, the prices are set for 5 types of dialysis services. The Institute pays the dialysis services at uniform, agreed prices.
In the hospital specialist activity a reimbursement payment per diagnostic related groups (Australian type) is used, combined with the fee for service system for some high cost services and materials. Number of days are followed statistically. The same system is in effect for the “one day hospital” and the “daily hospital”.
In the pharmacist activity, the fee for services system is in effect, while the medicaments on prescription and technical aids issued by the pharmacies are separately invoiced to ZZZS at their purchase prices. The Institute has contracts concluded with the suppliers of medical aids, providing, among other issues, also the prices of medical aids to be supplied on the account of compulsory health insurance.
In the health resort activity, the price of a non-medical daily charge is set, covering the services of residence and daily rations, and the value of a point of the health resort treatment.
In the area of the social care institutions and social habilitation institutions, the system of the average daily charge is in effect, according to the number of planned nursing types.
The operation of the emergency transport service is valuated with a planned budget for emergency transports and with price per kilometre for nonemergency transports, but last within planned number of kilometres. There is a separate price for transport service to dialyses and back.
Contributions for compulsory health insurance:
The compulsory health insurance contributions are paid calculated as a percentage of the specified bases.
The Law on Health Care and Health Insurance provides, in its Articles 50 to 57, the bases applied in calculation of the contributions for different groups of insured persons. The bases applied in calculation of the contributions were broadened by the Low on Contributions for Social Security. The obligors for contributions and the types of contributions to be paid for different classes of insured persons, are identified in the Articles 48 and 49 of the Law on Health Care and Health Insurance.
There is a relation between the types of rights of different categories of insured persons and the corresponding contributions.
The rates of contributions under compulsory health insurance are specified by the Law on Contributions for Social Security.
The compulsory health insurance contributions depend on the salary or other income earned by the insured person. This ensures a high degree of solidarity within the system. For some groups of insured persons (the unemployed, the recipients of the social security allowances and similar), the health insurance contributions are paid by national or local community budgets.
The amount of paid contributions in 2012 amounted to 2,27 billion EUR and has decreased by 1 % compared to 2011. The contributions paid in 2012 represent 97,7 % of the compulsory health insurance income by the ZZZS. The largest piece in the structure is provided by contributions paid by the employers and the employees (1,772 billion EUR, i.e. 76,4 %), followed by the contributions of pension fund (356,8 million EUR, i.e. 15,4 %) and the contributions of other contributors (133,7 million EUR, i.e. 5,8 %) and farmers (5,8 million EUR, i.e. 0,2%).