Abstract
Background: Slovenia's specialist outpatient healthcare system is gradually reforming its payment structure to promote comprehensive integrated care as part of the universal health insurance system (Health Insurance Institute of Slovenia – Slovenian abbreviation: ZZZS). These changes are an attempt to align it with the nine pillars of integrated care and the UN Sustainable Development Goal 3 for Good Health and Wellbeing in the best possible way.
Approach: Slovenia has initiated a comprehensive health care approach in specialist outpatient settings, focusing on developing payment models that encompass integrating at least some aspects of treatment. This approach includes:
1.Definition of comprehensive health care: In Slovenia, comprehensive health care is defined as a holistic approach that addresses all aspects of a patient's health, including prevention, diagnosis, treatment, and follow-up care, with an emphasis on continuity and coordination across different healthcare providers and services.
2.Introduction of case-based payment models: ZZZS has developed specific payment models for specialist outpatient settings that include first medical examination, procedures, and follow-up medical examinations for several specialist outpatient procedures. These include:
•Cataract surgery.
•Vascular surgery - varicose veins.
•Hernia surgery.
•Carpal tunnel surgery.
•Orthopaedic shoulder surgery and therapeutic arthroscopy (knee), and several others.
3.Gradual changes: The implementation of these payment models has been a gradual process, involving collaboration between healthcare providers, policymakers, and ZZZS.
The design and implementation of these initiatives involves collaboration between providers, policymakers, and the ZZZS. Recent efforts indicate a growing interest in patient-centred approaches with greater patient involvement.
Results: The implementation of integrated care and case-based payment models in specialist outpatient settings has shown promising outcomes:
1.Improved patient satisfaction: A national survey conducted in 2022 revealed high satisfaction rates among patients in specialist outpatient clinics.
2.Progress towards comprehensive care: The case-based payment models covering first examinations, procedures, and follow-ups have laid the groundwork for more holistic patient care.
3.Alignment with integrated care principles: The approach aligns with the pillars of integrated care, especially with the 8th pillar dealing with aligned payment systems.
Implications: The current case-based payment models in Slovenia's specialist outpatient settings offer valuable opportunities for further development:
1.Expansion to bundled payments: There is potential to expand the existing case-based payments into more comprehensive bundled payment models. This could include extended follow-up, functional tests, and other services to provide truly integrated care.
2.Broader application: The success of the current models suggests the possibility of expanding this approach to many other medical specialties and chronic conditions.
3.Technology integration: Investing in digital health infrastructure could further enhance care coordination and access to specialist services, supporting the 7th digital health solutions pillar.
In conclusion, Slovenia's progress in integrating specialist outpatient care through case-based payment models may provide a foundation for the development of more advanced bundled payment systems. Healthcare system in Slovenia can thus enhance its efficiency and effectiveness. However, the progress is slow and Slovenian healthcare system can still be regarded as fragmented and cumbersome.