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484 Economic crisis, health systems and health in Europe: country experience
businesses, but in accordance with the Law on Balancing Public Finances,
SHI contributions are now levied on short-term and part-time contracts
and on freelance writer contracts (2012).
Changes to health coverage
Population (entitlement)
• Entitlement to free statutory coverage restricted by changing the basis for
entitlement from the minimum wage to receiving social benefits (2012).
The benefits package
• Revision of the SHI drug lists (2009).
User charges
• Co-insurance rates increased from 5% to 10% (transplants, major
surgery, treatment abroad, intensive care, radiotherapy, dialysis and other
major diagnostic, therapeutic and rehabilitation tasks), 15% to 20% (in
vitro fertilization, infertility, sterilization and pregnancy termination;
orthopaedic; orthotic, hearing and other aids; outpatient, inpatient and
spa services; nonmedical care in hospitals and spas; some services in
primary care) and 25% to 30% (all treatment for occupational injury,
some drugs) (2009).
• Reduction of temporary sickness leave benefits from 100% to 90%
(for occupational illness and injury, transplants, blood donation), from
90% to 80% (sickness) and from 80% to 70% (non-work injury and
accompanying dependants when ill).
• Partly as a result of these reforms, OOP payments rose from 12.5% of
total health expenditure in 2008 to 13.7% in 2011.
Changes to health service planning, purchasing and delivery
Prices of medical goods
• SHI reduced drug prices through negotiation with suppliers and reduced the
price of dialysis (2009).
• Introduction of therapeutic groups for reference pricing (2012).
• Provision of information to the public regarding rational use of medicines
and of training in rational prescribing for physicians (2009).
Salaries and motivation of health sector workers
• No inflation-related increases applied to public sector salaries in 2009
and less than inflation rate increase to such salaries applied in 2010.
• Allowance for above-average performance abolished (2009).