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Country profiles of health system responses to the crisis | Slovenia 485 • Moratorium on new employment and compulsory retirement introduced for health workers meeting the criteria (2012). • Limits imposed on temporary employment and contractual part-time work (2012). • Effective reduction of health workers' salaries by 5–15% through the measures outlined above. • Reduction of on-call service payments by 5% (2011). Payment to providers • The Health Insurance Institute of Slovenia reduced the price of health services (generally) by 2.5%, additionally reduced expenditure on tertiary services by 5% and implemented penalties for health care providers related to breach of the contract between the fund and the provider (2009). Further reductions were made in 2010. • The Health Insurance Institute reduced the costs of administrative staff for providers and the costs of tertiary services, outpatient psychiatric care, positron emission tomography, computed tomography and expensive medicines used in hospitals only (2011). The total effect of these measures was a saving of €12.5 million in 2011 and it was estimated to be a further €11.1 million in 2012. • Payments to providers were reduced by 3% across the board regardless of previous signed prices in annual contracts; in the same year, the reduction of prices in contracts with the Health Insurance Institute eventually reached 8%, with contracts to hospitals automatically reducing payments by 5% (2012). These moves pushed hospitals further into deficit. Overhead costs: restructuring the Ministry of Health and purchasing agencies • Selective reduction of material and direct costs by the Health Insurance Institute (2009), without undergoing restructuring or any significant reduction in the number of employees or budgets. Provider infrastructure and capital investment • Investments were stopped or reduced as a result of central budget cuts (2008 and 2011) (but some previously planned investments in emergency services were continued). Priority setting or protocols to change access to treatments, coordination of care and patterns of use • Introduction of new protocols for care of patients with chronic conditions in primary care, which included the introduction of additional nurses tasked with preventive activities into the primary care team (2011). The aim was
486 Economic crisis, health systems and health in Europe: country experience to reduce the burden of preventive activities on family physicians, decrease the number of referrals to the secondary level and reduce the cost of primary care. Waiting times • Provision of extra funds to lower waiting times (2010). Health promotion and prevention • Alcohol and tobacco excise taxes increased (2013). • New excise taxes on soft drinks (2013).
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Economic crisis, health systems and
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The European Observatory on Health
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Keywords: DELIVERY OF HEALTH CARE E
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vi Economic crisis, health systems
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viii Economic crisis, health system
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List of abbreviations ACS Health in
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List of tables and figures Tables P
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xiv Economic crisis, health systems
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xvi Economic crisis, health systems
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xviii Economic crisis, health syste
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xx Economic crisis, health systems
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xxii Economic crisis, health system
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xxiv Economic crisis, health system
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xxvi Economic crisis, health system
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Acknowledgements This book represen
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Preface This book maps health polic
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Part I Country case studies
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4 Economic crisis, health systems a
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10 Economic crisis, health systems
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Chapter 4 The impact of the crisis
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Chapter 4 | The impact of the crisi
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Albania Genc Burazeri and Enver Ros
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Country profiles of health system r
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Austria Thomas Czypionka and Maria
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Azerbaijan Fuad Ibrahimov Economic
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Bulgaria Antoniya Dimova and Mina P
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Cyprus Elisavet Constantinou and Ma
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Czech Republic Tomáš Roubal and J
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Estonia Triin Habicht and Mall Lein
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Finland Jan Klavus and Lauri Vuoren
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France Karine Chevreul, Karen Berg
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Germany Klaus-Dirk Henke and Wilm Q
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Iceland Sigrún Gunnarsdóttir and
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Ireland Anne Nolan and Steve Thomas
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Israel Bruce Rosen and Amir Shmueli
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Kazakhstan Ninel Kadyrova and Tata
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Latvia Uldis Mitenbergs and Maris T
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Page 470 and 471: Malta Natasha Azzopardi Muscat Econ
Page 478 and 479: Montenegro Ratka Knežević Economi
Page 486 and 487: Norway Anne Karin Lindahl and Jon M
Page 504 and 505: The Russian Federation Elena Potapc
Page 508 and 509: Serbia Vukasin Radulovic Economic t
Page 520 and 521: Spain Enrique Bernal-Delgado, Sandr
Page 528 and 529: Switzerland Alberto Holly and Phili
Page 532 and 533: Tajikistan Ghafur Khodjamurodov Eco
Page 538 and 539: Ukraine Valeria Lekhan and Mariia T
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