At the Healthcare Consultation in the National Council of the Republic of Slovenia, Tina Bregant, on behalf of the Young Doctors of Slovenia, highlighted the many problems and delusions that the Slovenian healthcare system is facing. For decades, healthcare in Slovenia has suffered from a lack of proper governance and neglect, which is reflected in inconsistent infrastructure planning, inadequate human resources policies and a deformed pay system.
According to Tina Bregant, doctors are frustrated with the current situation and the lack of implementation of the reforms promised by the government of Robert Golob before the elections. “The government made promises that are not being fulfilled. While pretending to save the existing healthcare system, there is a parallel privatisation of healthcare according to the worst Balkan scenario going on, impoverishing hospitals and health centres, limiting the possibilities that could be offered by the holders of concessions, and forcing patients into self-pay services,” she said critically, among other things.
Bregant went on to recall the promises made by the Freedom Movement party (Gibanje Svoboda), the Social Democrats (Socialni demokrati – SD) and the Left party (Levica) regarding the healthcare reform, improving access to specialists (within 30 days) and strengthening the healthcare system. Despite all the promises, the situation in the healthcare sector has not improved. “By the 1st of January 2024, we were supposed to have a functioning e-file for every patient, a functioning wage pillar, and a solved problem of the patients without a personal doctor and a reformed emergency services network, as well as legislation prepared for the reform of the Health Insurance Institute of Slovenia (ZZZS), modernisation of the management of public institutions, a regulated area of absenteeism, a reformed healthcare network as of the 1st of January 2025, redefined concessions, etc.,” the coalition promised in its pledge to the citizens, but none of this has materialised.
The doctor also specifically highlighted the problem of the abolition of supplementary health insurance, which was replaced by a new compulsory contribution, which brought many organisational problems and practical conundrums “and the largest recorded negative contribution by the Health Insurance Institute in its history”. “We can therefore expect further increases in this contribution in the future, while at the same time, there is no sign of a reorganisation and modernisation of the Health Insurance Institute.”
The Young Doctors have also expressed their disagreement with the possibility of setting up outpatient clinics for family medicine doctors in training, as they believe that a doctor must pass their specialist examination before working independently. “Only on the basis of this can he or she safely and responsibly take over the treatment of patients in an independent outpatient clinic,” they were clear. They also expressed concerns about the introduction of compulsory refresher courses in resuscitation based on simulation-based learning, as this could lead to corruption.
With each departure, the situation for the remaining team members deteriorates exponentially
Despite its promises, the government has failed to improve working conditions in hospitals and health centres, leading to the departure of medical staff or relocation to foreign countries, and the longest medical strike in Slovenia’s history. “With each departure, the situation for the remaining team members deteriorates exponentially, which inevitably leads to new departures, burnout and abandonment of the profession,” Bregant said, pointing to international outrage at the poor communication between the Ministry of Health and the unions and the restriction of doctors’ constitutional right to strike. “They have expressed their support for Slovenian doctors in their fight for basic labour rights and better working conditions by signing an official statement, which has also been sent to and accepted by senior European medical institutions and the international media.”
Negative public opinion about doctors increases the risk of violence against healthcare professionals
It was also pointed out that the government is actively creating a negative public opinion about doctors, which increases the risk of violence against healthcare staff and undermines the trust between patients and doctors, which is otherwise crucial for a successful treatment outcome. They also noted the increasing censorship on social networks, “even the private profiles of doctors and intellectuals, which expose the mistakes and failed projects of the current administration, are not safe.” The Young Doctors also highlighted the problem of obtaining permits for doctors to work in the afternoons, which is leading to a further deterioration of the situation in healthcare.
Bregant also highlighted the problem of inefficient use of European Union funds, which could have been used for the renovation of critical infrastructure, such as the University Health Centre Ljubljana, and the purchase of medical equipment. “According to information from the staff at the Ministry of Health, this is because EU funding makes corruption impossible,” she said, referring to the inefficient use of EU funds. As the Young Doctors were involved in the plan to revamp the network of emergency centres, they pointed out how the whole project had failed to be implemented. “The unregulated field is also the reason why there is less and less interest in specialising in emergency medicine – in the last call for tenders, only 5 candidates applied for 29 places. The youngest doctors are showing similar levels of interest in family medicine, where the current minister has made working conditions even worse.” It was also pointed out how there is a great shortage of doctors and nurses at the Ljubljana emergency room. “With a growing shortage of medical staff on the periphery, the number of patients at the central emergency room is only increasing. We cannot help but wonder what will happen when the country’s last highly specialised internal medicine first aid department goes down.”
“As an example of the stalling of cutting-edge treatments, the current issue of radionuclide treatment of prostate cancer is also topical. Currently, Slovenia is the only country in the EU that does not have its own cyclotron and associated PET radiopharmacy, which would significantly improve the supply of PET radiopharmaceuticals (crucial for adequate pre-therapeutic diagnostics) and thus enable a greater number of PET examinations to be performed at a lower cost,” it was particularly pointed out. The Young Doctors also highlighted the long waiting times, government by decree, mass departures of staff from the Ministry of Health and the drafting of laws (the Digitalisation Act and the Quality in Healthcare Act) which “each envisage the creation of an additional agency to channel public funds into the pockets of a select few.” They are critical of the announced law on the delimitation of public and private health care, which, without improving conditions in state institutions, will further worsen the situation in healthcare, as many professionals will be driven out of the public institutions into private healthcare, “where they will not perform the most difficult interventions that each of us may potentially need at some point in the future.”
Finally, Bregant appealed to all decision-makers in Slovenian healthcare to advocate for real change and prevent the situation from deteriorating further. Her message is clear: “The emperor has no clothes!”
Ž. N.
