Slovenia: general practitioners missing

In Slovenia, the healthcare system, once a flagship of the country, seems to be on the verge of an irreversible crisis that risks leading to the dismantling of the public system in favour of the private sector

In Ljubljana this season it is cold at night, but fortunately this year the weather is mild. The elderly patients had dressed up to the max, some had even brought camping chairs and blankets. All lined up, some even from the night before, in front of one of the city's local healthcare facilities. Word had spread that two new doctors had arrived and that they would take care of the patients left without one. In the country, losing a general practitioner has become a real tragedy. Without them, it is difficult even to get a prescription for the simplest medicines. So all that remains is to go and clog the emergency rooms, which instead of dealing with serious and urgent cases find themselves having to assist patients who simply need an antibiotic or antipyretic.

In Slovenia there are 130,000 people without a general practitioner. A calamitous reform made under the centre-left government of Marjan Sarec has reduced the number of patients that every doctor has to take care of. At the time, the category protested because it could no longer cope with the tide of paperwork that the cumbersome public system imposed on them. The solution was to reduce patients and not bureaucracy. However, the reassurance had been that no one would ever be left without a general practitioner – never did a promise turn out to be more deceiving.

Healthcare in Slovenia has always been a flagship of the country. Already at the time of Yugoslavia the system worked better than elsewhere and it is no coincidence that the University Hospital of Ljubljana was considered the best hospital in the federation, so much so that even Marshal Tito, the boss father of the country, came right here to fight the his last “great fight”. The one that he inexorably lost.

Over time, doctors in Slovenia have become a powerful corporation, which has above all stamped its feet to get higher salaries. Thus, each government found itself grappling with reproaches, protests, and strike threats from their fierce union. Each one gave in. Meanwhile, the big dream seems to be to dismantle the public system and switch to healthcare increasingly in the hands of private actors in order to make tons of money.

But let's start from the beginning. In principle, the national healthcare system offers free basic assistance to all citizens. The contributions to make it work are deducted from salaries and paid with income tax. Every citizen can avoid tickets by stipulating an additional insurance equal to 35 Euros. This latter has been at the centre of considerable controversy, as the money goes to into the pockets of private insurance companies and does not fund the healthcare system directly. This was also one of the reasons for the collapse of the centre-left government of Marjan Sarec and the advent of the latest government of Janez Jansa. The radical left, in fact, had withdrawn its external support to the government in the face of the desire to leave the contribution unchanged. Doctors in Slovenia have been placed under the civil service salary system. A specific grid regulates the salaries of healthcare personnel, teachers, public service journalists, ministerial employees, and the entire political class up to the head of state. The mechanism, which avoids excessive inequalities, however provides for a whole series of additions according to the complexity of the work and additional tasks. One of the concerns of the political class so far has been not to compromise the system that keeps the wages of various professional categories in balance. In any case, doctors are those who have managed to get the most out of the system in all these years. Suffice to say, 48 out of the 50 highest salaries paid in the public administration go to doctors, who earn more than the president of the republic, ministers, and deputies.

Furthermore, many have also been authorised to work not only in the public system but also in private clinics; others have resigned and now, having become entrepreneurs, with their companies or simply as freelancers offer their services to the public system, even in the same local healthcare institutions which they left. In the end, the system seems to be on the verge of collapse: there is a shortage of general practitioners and the waiting lists for specialist check-ups are getting longer and longer. To solve the problems, all you need is money. In fact, private insurance companies are proliferating, offering packages that ensure visits and treatments in a few days and often, by paying the service with a regular invoice, one can be visited by a specialist virtually immediately.

The government, led by the umpteenth new face of the Slovenian centre-left, is once again demonstrating that it does not quite know which way to turn. To address the lack of general practitioners, Prime Minister Robert Golob has promised hefty compensation to those who will go to work in the clinics that will take care of these patients left without assistance, while announcing yet another package of salary increases for doctors and not only. The minimum wage was increased by 100 Euros, while for the judiciary, dissatisfied with its wages, inviting the Prime Minister to one meeting was enough to obtain the promise, to general amazement, of a 600 Euro monthly increase for the whole category. Raises were promised also to kindergarten teachers who had only threatened to take to the streets. Now the military has already come to cash in and probably other categories will do the same in the coming weeks and months. Where the government will find the money remains a mystery – the radical left has suggested raising taxes on capital and real estate.

What does seem clear, however, is that for the centre-left it is easier to beat Jansa and the centre-right in the elections than to govern and develop a clear plan for the future. Golob, however, compared to its predecessors has something extra. He has managed to surround himself with a plethora of worshippers and figure out how to use populism to build consensus. In short, everything a successful leader in Eastern Europe needs.