HEALTH CARE

2.16.1 General findings and assessment of the situation

In the field of health care and health insurance, we considered 130 complaints in 2019; 17.4 per cent of which were justified, which is significantly more than in 2018 when the figure stood at five per cent.

The trend shows that caseload and justification in the field of health care and health insurance have remained unchanged since 2013 with the exception of 2018.

Since 1991, the Ministry of Health has been headed by 17 ministers. This is un- doubtedly reflected in the work of the Ministry, its work organisation, the (non-) resolution of systemic issues, such as a health care reform in the field of health care and health insurance, and the backlog of cases that require inter-ministe- rial cooperation. The communication of the Ministry with citizens and the Om- budsman is poor. The Ombudsman must intervene several times for the Ministry to respond. Responses are frequently substantively insufficient, and the Ministry foresees solutions to problems in long promised new legislation (which was not yet in public discussion when we prepared this report).

There were no significant changes in the normative regulation of health care in 2019; therefore, all current comments remain in place. Despite the assurances of the Ministry, there is as yet no new health care and health insurance act. It has been announced several times, but is still non-existent; the rights of insured persons continue to be regulated by an implementing regulation, which is an inadmissible violation of Article 15 of the Constitution of the Republic of Slo-

CASES CONSIDERED RESOLVED AND JUSTIFIED

FIELD OF WORK 2018 2019 INDEX 19/18 NO. OF RESOLVED NO. OF JUSTIFIED SHARE OF JUSTIFIED AMONG RESOLVED

HEALTH CARE AND

HEALTH INSURANCE 231 130 56.28 92 16 17.4

HEALTH INSURANCE 47 49 104.26 35 6 17.1

HEALTH CARE 184 81 44.02 57 10 17.5

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venia, established by a decision of the Constitutional Court of the Republic of Slovenia.

The Health Insurance Institute of Slovenia (ZZZS) sends us the required responses promptly, but these are frequently substantively insufficient.

These are the reasons for a high percentage of justified complaints in the field of health care in its wider meaning.

problems with which complainants contacted the Ombudsman were very diverse and did not differ significantly from those of previous years. The content may be summarised in the following classifications: dissatisfaction with health care, atti- tude of health care workers, poor organisation in health care institutions, waiting times, the lack of normative regulation in certain fields, and lengthiness and vio- lations of procedures managed by the ZZZS.

In justified cases, we found violations of the right to health care, social security, unjustified delays in proceedings, but also of the principles of sound administra- tion and procedure.

In November 2019, the Ombudsman met the General Manager of the ZZZS as part of working meetings with state authorities. At the meeting, the Ombudsman cited specific violations established regarding the operation of the ZZZS. At the meeting with the Minister of Health in January 2020, the Ombudsman pointed out that with health reforms the state should ensure accessible, high-quality and safe disease prevention, treatment and rehabilitation programmes, while also reducing inequalities and ensuring accessible health care to all groups of peo- ple. At the meeting, we were assured that the proposed new health care and health insurance act and the long-term care act would be submitted for public discussion by the end of February 2020.

2.16.2 Realisation of the Ombudsman’s past recommendationsl

The Ombudsman’s past recommendations that remain partially realised or fully unrealised are highlighted below:

• recommendation no. 38 (2018) with which the Ombudsman recommended that the Government draft amendments to the Patient Rights Act which will take into account the fact that regulations from the field of health insurance also govern the majority of these rights;

• recommendation no. 39 (2018) with which the Ombudsman recommended that the Ministry of Health prepare a comprehensive analysis of reasons for waiting times and of the systemic organisation of health care, and proposals to eliminate administrative barriers and simplify procedures that will respect patients’ time;

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• recommendation no. 63 (2017) with which the Ombudsman recommended that the Ministry of Health study applicable protocols for gynaecological ex- aminations of victims of sexual violence and establish whether they provide an opportunity to select a gynaecologist who will inspire confidence in victims and not add to their distress or make them feel uncomfortable;

• recommendation no. 41 (2018) with which the Ombudsman recommended the Communicable Diseases Act be amended accordingly after the completed analysis in order to further ensure suitable protection from communicable diseases, and observe scientific and expert findings regarding the risks and adverse effects of vaccination;

• recommendation no. 42 (2018) with which the Ombudsman recommended that the Government of the Republic of Slovenia examine the possibility that an appeal against the decision of an appointed physician would suspend its execution;

• recommendation no. 60 (2017) that the Ministry of Health execute a broad- er awareness-raising campaign for all citizens regarding new legal solutions, particularly their rights and procedures for enforcing these rights, after all the planned acts implementing health reform and governing patients’ rights come into force;

• recommendation no. 61 (2017) that the Ministry of Health draft criteria for determining a network of health care providers without undue delay, on the basis of which the Government will determine the network in 2018, providing equal opportunities for public and private health care providers and equal access to providers for users;

• recommendation no. 54 (2016) that the Government of the Republic of Slove- nia require all state authorities drafting individual regulations with the help of external experts to publish details of how their working groups are structured, what their basic duties are, and the time limits for drafting expert groundwork.

• recommendation no. 55 (2016) that the Ministry of Health in cooperation with the Information Commissioner study the option for the Patient Rights Act to lay down the possibility of releasing doctors from their obligation to profes- sional secrecy when a patient has already publicly disclosed sensitive infor- mation about their medical condition;

• recommendation no. 57 (2016) that the Ministry of Health draft in 2017 legis- lation on the performance of psychotherapy services;

• recommendation no. 58 (2016) that the Ministry of Health in cooperation with the Health Insurance Institute of Slovenia study the possibility of a price breakdown of health care services (into labour and material costs), as this would enable a greater overview of the funds spent, and make it possible for complainants to select a surcharge for above-standard services;

• recommendation no. 59 (2016) to regulate the rights of individuals that arise from compulsory health insurance and dependency on their place of resi- dence by law;

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• recommendation no. 60 (2016) that the payment of an inadequate amount of sick-leave compensation based on false grounds and concerning which no judicial proceedings are pending be regulated by law retroactively, ensuring equal treatment for all beneficiaries;

• recommendation no. 70 (2015) that it is necessary to inform the public in advance of any qualitative changes, stating the reasons for such changes and their basic content;

• recommendation no. 71 (2015) that the Ministry of Health also examine pro- posals for the work of advocates of patients’ rights to be expanded to the field of compulsory health insurance;

• recommendation no. 72 (2015) with which the Ombudsman proposed that the Ministry of Health examine the possibility of combining the tasks of advo- cates of patients’ rights and advocates of persons with mental disorders in the light of new legislative solutions;

• recommendation no. 72 (2015) with which the Ombudsman proposed that the procedures with respect to the right to medical treatment abroad be reg- ulated in more detail;

• recommendation no. 124 (2013) with which the Ombudsman recommends that the Ministry of Health promptly prepare the foundations for health care and health insurance reform, and organise a wide public debate involving all interested parties. The public discussion should include several alternative solutions supported by all relevant information, particularly regarding the fi- nancial consequences for patients. (page 265);

• recommendation no. 125 (2013), with which the Ombudsman recommends that the Ministry of Health promptly establish organisational reasons for vi- olating individual patients’ rights, especially the right to respect for patients’

time, and imposes on the managements of health care institutions to pre- pare plans for their elimination. Organisations of patients and their relatives should also take part in the preparation of such plans.

• recommendation no. 126 (2013) that the Ministry of Health examine the reg- ulatory framework of complementary and alternative medicine and individual treatment methods, and on this basis prepare suitable legislative amend- ments that will ensure providers have free financial choice and provide users with the right to select their treatments;

• recommendation no. 127 (2013) that the Ministry of Health include in new health legislation the obligation of health care institutions to promptly inform parents about whether they will be entitled to wage compensation during a hospital stay with a child.

The online edition of the annual report available on the Ombudsman’s website includes additional substantive explanations regarding the (non)realisation of past recommendations.

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2.16.3 The Ombudsman’s new

recommendations and activities

2.16.3.1 Recommendations

On the basis of the cases considered in the field of health care and health in- surance, we drafted the following recommendations:

94. The Ombudsman recommends that the Ministry of Health raise aware-