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Ozadje: Zdravstvena reforma v Sloveniji leta 1992 je imela pet glavnih ciljev - uvedbo sistema socialnega zdravstvenega zavarovanja in sistema doplačil za različne zdravstvene storitve, uvedbo zasebnega dela v zdravstvenem varstvu, prenos funkcij načrtovanja in nadzora z države na zbornice in občine ter uvedbo licenciranja in obnavljanja licenc za zdravstvene delavce. Metode: Zaradi osredotočenja na reforme sistema financiranja smo opravili opisno in eksplorativna analiza splošnih demografskih, ekonomskih, splošno- ter zdravstveno-finančnih podatkov. Predstavili smo tudi splošne populacijske kazalce zdravja za celotno opazovano obdobje. Širši zdravstveno politični kontekst smo ovrednotili s pomočjo metode opazovanja ob sodelovanju skozi celotno obdobje ter z uporabo polstrukturiranih intervjujev s ključnimi oblikovalci zdravstvene politike v letu 2001 kot vmesno analizo stanja. Rezultati: Pretvorba zdravstvenega sistema v Sloveniji je privedla do stabilnega financiranja zdravstvenega varstva na ravni okrog 8,5 % BDP. Tak rezultat smo dosegli na račun zmanjšanja deleža, financiranega iz javnih sredstev, kar smo delno nadomestili z dopolnilnim zdravstvenim zavarovanjem, delno pa z zasebnimi izdatki. Zasebni izdatki so povečali regresivnost sistema, kar smo delno zmanjšali z izravnalnimi shemami, delno pa s subvencioniranjem dopolnilnega zdravstvenega zavarovanja za najbolj finančno ogrožene. Zaključki: Tranzicija zdravstvenega sistema v Sloveniji se je odvijala v obdobju ugodnih ekonomskih razmer, kar je omogočilo stabilno financiranje sistema zdravstvenega varstva in omejilo zmogljivosti izvajalcev zdravstvene dejavnosti. Tako okolje je pomembno vplivalo na izboljšanje splošnih razmer za zdravje prebivalstva in je zmanjšalo pritiske na nov sistem. Prejšnji sistem se je pretvoril v mešani sistem socialnega zdravstvenega zavarovanja, zasnovan na močnem osrednjem zavarovalcu. Sedanja shema financiranja ne bo zdržala dolgo zaradi demografskih trendov in drugih dejavnikov, ki povečujejo nekrite potrebe po zdravstvenem varstvu.Background: Slovenia\u27s 1992 health reform set the following five goals: introduction of social health insurance system and a system of co-payment fora range of health care servicesintroduction of private practice in healthcaredevolution of planning and control functions from the State to professional associations and municipalitie, and introduction of licensing and recertification for health professionals. Methods: A descriptive and explorative analysis was done of general demographic, economic and health financing data and the reported data on financing structure. The general population health indicators for the observed period are presented. A broad health policy context was assessed through participatory observation during the whole period and using semi-structured interviews with key national healthpolicy-makers in 2001, which served as a mid-term review. Results: Transformation of health care system in Slovenia led to sustainable health care financing at a level of approx. 8.5% of GDP. This result was achieved atthe expense of reduced public funding, which was partially compensated for by the supplementary health insurance and partially by an increase in out-of-pocket expenditures. Private expenditures increased the system\u27s regressivity, which was corrected through risk-equalising schemes and by subsidising supplementary health insurance to the least well off. Conclusions: Slovenia\u27s health care transition took place during a period of economic growth, which afforded stable financing of the system and restricted the capacity of health care providers. This environment had a favourable impact on the general health situation of the population, and thereby reduced pressures on the new system. The previous system was transformed into a mixed social health insurance based system, based on a strong central insurer. The present financing scheme is unlikely to remain sustainable because of demographic trends and other drivers increasing unmet health care needs

Balancing equity and efficiency through health care policies in Slovenia during the period 1990-2008