Policy responses for Slovenia - HSRM

Slovenia


Policy responses for Slovenia

3.3 Maintaining essential services

Update 20 October:

Several interventions to improve and ensure provision of health care have been introduced, including:

- a national tender for the improved access to health care services.

- a free voluntary flu vaccination against seasonal flu.

- possibilities of sickness absence because of disease with certificate issued by the personal doctor (GP) for up to three days.

- the state budget to finance one month's worth of protection mandatory stockpiling of PPE, co-finance PPE for the employees and providers as well as co-finance purchases of medical equipment necessary for the control of spread and treatment of infection with COVID-19.

The Ministry of Health published a Decree on 20 March 2020 on temporary measures in health services due to the need for containment and control of covid-19 epidemic (https://www.uradni-list.si/glasilo-uradni-list-rs/vsebina/2020-01-0708/odlok-o-zacasnih-ukrepih-na-podrocju-zdravstvene-dejavnosti-zaradi-zajezitve-in-obvladovanja-epidemije-covid-19 ). The decree introduced the following measures:
1. Put an immediate hold on all preventative measures and programmes
2. Put a hold on all outpatient visits and appointments with exception of those marked as urgent or very urgent, oncological services of all types and monitoring of pregnancy and delivery
3. Put a hold on all dental services

The exceptions to the above were emergencies that are life-threatening, both medical and surgical. These are managed in the so-called ‘white areas’ of hospitals (as opposed to red or hot areas where COVID-19 is managed).
Eight dental entry points were established across Slovenia for the entry of urgent dental cases.
On 7 April 2020, the Ministry of Health issued a modification of the decree where the following services  were exempted additionally (on the condition that all recommendations as published at the homepage of NIJZ are respected when managing patients):
1. All procedures, which if not provided could cause a significant worsening of the person's health condition
2. Essential prior medical check-ups before employment
3. Health services for firemen in active service
Healthy pregnant women will have less examinations during the pregnancy compared to the number of visits foreseen by the national guidelines followed in normal times, and the partner/husband is currently not allowed to be present at childbirth. These measures apply for the duration of the pandemic. From 28 April 2020, women in labour can be accompanied by their partners during delivery, provided they both tested negative and that they are both wearing appropriate PPE.
As mentioned above, there is currently a trend to reopen some essential services, which would be important for chronic patients in order to prevent their underlying condition to worsen.
There is an awareness of the need to support vulnerable people with long-term care needs and to discharge to social care but there is very little support in place. The President of the Government called upon healthy young people, especially students, to volunteer in helping the elderly, and mayors to organise such supportive services.

Since 9 May 2020 all planned types of services can be performed again but rather limiting instructions are posing a challenge to the providers. Many dentists announced they would reinstate services gradually.
The main challenges have been longer time needed per patient limiting access to services, and stockpiling for costly PPE.

There has been a widespread impact of the COVID-19 epidemic on the delivery of health care services. Data on the first seven months of this year have been published and show that the number of GP consultations decreased by more than 30% and the number of hospital discharges decreased. The impact on the outpatient specialist services varied by specialty. There was no change in service uptake in oncology, dialysis or emergency cardiology. However, the number of planned elective interventions in orthopaedics saw a reduction of more than 40%. There were also breaks in cancer screening uptakes but all cancer screening programmes have successfully resumed, some starting already by mid-May. It is expected that most cancer screening programmes will meet usual targets by the end of this year.

There is more uncertainty about the well-established annual check-ups for chronic patients in the GP practices in primary health centres that run monitoring programmes for this group. The National Institute of Public Health (NIJZ) set up requirements for primary health centres responsible for these programmes. In order to have their annual performance fully recognised, they must conduct at least 30% of the annual quota. The check-ups for chronic patients have been on hold since the declaration of the epidemic on 12 March 2020, mostly due to the fact that nurses running them were deployed to COVID-19 entry points.