In recent days, the government has announced that it has tabled an amendment to the law abolishing supplementary health insurance. But then Robert Golob said that they want to freeze the prices of supplementary insurance with the tabled amendment, thus preventing insurance companies from making private profits, paediatrician Tina Bregant said at the beginning of her commentary on the developments around the abolition of supplementary health insurance.
“If they do not change their proposal, then they are NOT abolishing supplementary insurance, they are just transferring it to the Health Insurance Institute of Slovenia, which is actually a centralisation of funds (and a kind of nationalisation of insurance companies). With this manoeuvre, the government is giving an extra 600 million to the Health Insurance Institute, which was already questionably managing the money it collects, because it was not paying for all the services, or if it was, these services were grossly underpaid and for many years not even in line with inflation. While a few services stood out for being well paid (e.g. radiology), the service that requires the most medical expertise, i.e. the medical history and clinical examination, which is technically the cheapest and, at the same time, the most important for the patient, remained grossly underpaid,” said Dr Tina Bregant.
Therefore, this political manoeuvre does NOT regulate the functioning of the Health Insurance Institute, which should be restructured for the benefit of the payers – the patients. Namely, it should consider a reorganisation of work, the way services are paid for (according to the principles of quality and safety, respecting the principles of Health Technology Assessment, relieving doctors of the administrative procedures that they are now having to do instead of the Health Insurance Institute and its employees, etc.).
This manoeuvre is unsustainable in the long run and will lead to a draining of the budget.
It is true that in this way, they are forcing the few citizens who did not pay for supplementary health insurance to do so now, Bergant added. “On paper, they will also partially solve the problem of ‘out of pocket’ payments, which includes supplementary health insurances, but – and I believe this will come true – other, additional insurance will increase, because this political manoeuvre will make it no faster and no better for people to access services in public institutions. What is more, this manoeuvre is unsustainable in the long run, unless there is a simultaneous restructuring of the work of the Health Insurance Institute, and it will lead to a draining of the budget. Not to mention the hidden burden on labour and employer costs and on pensioners.”
Is this just a case of “if my cow dies, the neighbour’s cow should die, too”?
If their main purpose is to prevent profits for those who have organised themselves and work differently from the Health Insurance Institute – or even operate at a profit, which the Health Insurance Institute clearly cannot do (as the Health Insurance Institute should use the “profit” to buy new equipment, renovate buildings used for healthcare services, etc.), then this is just a case of “if my cow dies, the neighbour’s cow should die, too,” according to Bregant. “So, it is clearly not a question of the Health Insurance Institute being able to model itself on more successful insurance models that would put taxpayers’ funds back into the system, but merely of amateurism and populism, of abolishing something that is not optimal but somehow works, and replacing it with a large, dysfunctional system that will only proliferate. Is that why this regulation is only increasing the funds on the national Health Insurance Institute’s blank cheque? For what and for whom?”
Bregant also said she is in favour of abolishing supplementary health insurance, but first, the functioning of the Health Insurance Institute must be regulated, the way it works must be changed, quality and safety must be ensured, separate baskets must be created, and, of course, co-payments must be regulated. This is what supplementary health insurance has regulated up to now, and simply transferring funds from one insurance company to another will not sort this out. This ‘other’ insurer has repeatedly “proved itself” by not paying for services.
In defence of the Health Insurance Institute, however, we need to point out an unpleasant fact: in Slovenia, we raise little money in absolute terms for all the services we want, which cost about the same in Europe, Bregant believes. “Unfortunately, medicine (and even more so the area of pharmacy) does not take into account the GDP of a country and the purchasing power of its population. Yes, we can still find some reserves in the organisation of work, in a more rational use of medicines, and perhaps a serious discussion is needed on medicines for rare diseases, where almost 6 percent of the funds are spent on 0.1 percent of the population, a discussion on suppliers is needed, as well as on prices of medicines and medical devices, centralised procurement, compliance with Health Technology Assessment guidelines, etc. There are some reserves left. But above all, it is time for the amateurs in healthcare to stop learning from their mistakes, which we will all have to pay for.”
We are nearing the bitter end of public healthcare …
Clearly, the tinkering with healthcare is not over yet. We are nearing the bitter end of public health care, because this swinging from one extreme – privatisation of healthcare, to the other – centralisation and nationalisation, is only creating chaos. And chaos and anarchy tend to lead to looting. They are like rough, muddy waters, where predatory fish do best…