development report 2012 - UMAR

196 Development Report 2012
Indicators of Slovenia’s development
Health care resources
Given the labour-intensive nature of health services,
the effectiveness of the health care system is highly
dependent on capable and motivated health care
workers. The shortage of health care workers, their
inappropriate geographical distribution or imbalance
in the various health professions are usually
attributable to inappropriate human resources
planning, which results in difficulties in delivering
high-quality, efficient and cost-effective health care
and ensuring equity in access to health care services.
Although the number of physicians has been growing
somewhat more strongly in recent years, Slovenia’s
gap to the EU and OECD average nevertheless
continues to increase. According to data of the Institute
of Public Health, the number of practicing physicians
totalled 4,979 in 2010, 1.3% more than in 2009. The
indicator of the number of practicing physicians per
100,000 population has improved as well, reaching
243 (2009: 240.7; EU: 330.5). According to the OECD’s
estimate, the number of physicians grew by an average
of 1.0% annually in Slovenia in 2000–2009, in OECD
countries by 1.7%, and in the EU by 1.5%, according to
our estimate. This means that Slovenia’s gap with the
OECD and the EU widened in 2000–2009. Slovenia lags
most notably in the number of general practitioners
(49.8 per 100,000 population in 2010; in the EU-27: 87.4
in 2009), which is problematic as regards both access
to health care services and the cost effectiveness of
the health care system (the role of ‘gatekeepers’; 1 a
possibility of transferring certain health care services
to the primary level). In 2010 and 2011, Slovenia took
certain measures to strengthen primary health care: (i)
introduction of new training primary health care offices,
in which doctors specialising in general medicine can
register their patients (under tutorship); (ii) introduction
of reference primary health care offices, in which
registered nurses assume greater responsibilities; and
(iii) additional funding for the primary level of health
care (Ministry of Health, 2012).
The number of medical graduates increased
significantly in 2010. As the first generation of
medical students graduated from the Maribor Faculty
of Medicine in 2010, the number of medical graduates
rose to 229 (2009: 162). The indicator of the number of
medical graduates per 100,000 population therefore
increased significantly in Slovenia, from 8.0 in 2009
to 11.2 in 2010 (the 2000–2009 average was only 7.0).
Consequently, Slovenia exceeded the OECD average
(9.9) in 2010, after having still lagged significantly
1
At the primary level, general practitioners also have a
gatekeeping role, meaning that they reduce the extent of more
expensive specialist outpatient health care services.
behind in 2009. Most countries are addressing
physician shortages by increasing enrolment at
medical schools and by making it easier for foreign
physicians to obtain licences. In 2010, Slovenia
increased enrolment at the Faculty of Medicine
in Ljubljana and Maribor by 30 additional posts.
Furthermore, it also passed a new law 2 that shortens
the procedures for the recognition of professional
qualifications for foreign doctors.
The number of registered nurses (i.e. nurses with
a university degree) is rising (too) fast. In 2010,
Slovenia recorded 804 medical technicians and
nurses 3 per 100,000 population, which is somewhat
lower than the EU average (824 in 2009), while the
number of nurses per physician (3.3 in 2009) was
significantly higher than the OECD average (2.5).
Owing to a number of new university colleges of
nursing, the number of registered nurses in particular
has been growing significantly in recent years. A total
of 247 nurses graduated in 2010, 60% more than in
2005. Judging by the number of enrolled students,
the inflow of graduates is set to increase strongly in
the coming years, according to the estimate of the
Institute of Public Health – in 2011 already by as
much as 80–100, and by an additional 50 in 2013. The
high inflow of nurses to the labour market will have
to be regulated by additional systemic measures in
both health care (a further transfer of certain duties
from doctors to registered nurses) and long-term care
(faster development of long-term care at home). In
light of limited hiring in the public sector, registered
nurses may have difficulty finding jobs otherwise.
There is practically no gap between the dynamics of
the decline in the number of acute hospital beds in
Slovenia and the relevant dynamics in the EU. The
number of acute hospital beds is declining on account
of the shortening of the average length of inpatient
stay and the transfer of certain hospital treatments
to more patient-friendly and also less costly, dayhospital
or specialist outpatient clinics. In 2000–2009,
the number of acute hospital beds per 100,000
population dropped by 16% in Slovenia, on average,
and by 18% in the EU. At the same time, access to acute
hospital treatment improved in Slovenia (a shortening
of waiting lists and an increase in the hospitalisation
rate), which leads to the conclusion that the dynamics
2
The Act on Recognition of Professional Qualifications of
Medical Doctor, Specialist Doctor, Doctor of Dental Medicine
and Dental Medicine Specialist (OG RS, No. 107/2010) expedites
procedures for recognition of professional diplomas obtained
in countries which are neither EU Member States, EEC Member
States nor the Swiss Confederation.
3
According to data of the Institute of Public Health, 4.333 nurses
and 12,423 medical technicians were employed in Slovenia at
the end of 2010.