STA, 11 January 2019 – Gynaecologists (ginekologi) in Slovenia have too many women enlisted as their patients, which leads to lower-quality examinations and longer waiting times. They thus urge authorities to reduce the number of women per gynaecologist to preserve the achieved high level of gynaecological care.
Medical Chamber representatives told the press in Ljubljana on Friday that a shortage of gynaecologists and ever new generations of women entering the system had affected access to gynaecologists.
They believe at least 30 new gynaecology teams would be needed to cope with the shortage and take the pressure off overburdened gynaecologists.
In 2018, a gynaecologist had an average of 4,800 women enlisted as their patients, while the college of gynaecologists and obstetricians maintains 4,000 would still be an acceptable figure.
However, some gynaecologists had even more than 7,000 women enlisted, explained Domžale Medical Centre gynaecologist Petra Meglič, who treats some 6,200 women.
All women, including girls aged at least 13, are entitled to choose their personal gynaecologist in Slovenia.
Since some 700,000 women have their personal gynaecologist, gynaecologists carry out more than 1.5 million medical examinations a year.
Another burden is a number of administrative tasks gynaecologists are obliged to carry out, which further shortens the time they have for their patients.
Gynaecologists are, moreover, getting older; in 2017, out of a total of 361 active gynaecologists, 160 were older than 50 and 82 older than 60.
Some 300,000 women could remain without their personal gynaecologist due to retirements in the coming years.
"Young specialists prefer to work at hospitals, as working in a gynaecology office is extremely specific, with constant high pressure to process a mass of women," said Meglič.
She also said her office rejects 10 to 20 women who have not yet chosen their personal gynaecologist a day.
According to gynaecologist Renata Završnik Mihič, young doctors are eager to specialise in gynaecology, yet not enough residencies had been opened over the past years to make up for the shortage that would stem from retirements.
The system is working only because gynaecologists assume ever more work, which leads to burn-out.
They thus called on authorities to overhaul the standards governing the number of women patients per gynaecologist, which were adopted in 1994, taking into account population ageing and new discoveries in medicine.
In this way, the country will preserve its quality gynaecological care, few unwanted and teenage pregnancies, relatively few abortions and a low rate for cervix cancer.
STA, 7 January 2019 - The URI Soča rehabilitation centre in Ljubljana launched on Monday a new device for gait rehabilitation for severely impaired neurological patients. The Lokomat device provides supported, automated and computer-guided training for persons with impairments of the central and peripheral nervous system who are not able to stand or walk independently.
"The robot connected with virtual reality enables gait training for patients who would otherwise not be able to start it so early into rehabilitation," URI Soča medical director Helena Burger told the STA at the ceremony.
The device will make rehabilitation and its effects faster, as it ensured highly intensive learning with numerous repetitions of a steady and symmetric gait.
URI Soča director general Robert Cugelj added that they wanted to establish a centre of modern technologies by 2020, which would provide patients with services in line with the European rehabilitation guidelines.
The centre would provide rehabilitation with robotised equipment and virtual reality equipment at one place.
A patient using the Lokomat praised the device he uses three times a week for 30 minutes. He said the exercise was exhausting, but beneficial, as it helped him get closer to walking independently, which had seemed impossible at the start of the rehabilitation.
The purchase of the EUR 400,000 device was financed by the Health Ministry. Minister Samo Fakin said that the introduction of new medical technologies and therapeutic methods was important if patients in Slovenia were to be provided with best treatment.
Cugelj meanwhile noted that the biggest problem for URI Soča at the moment was development of neurological rehabilitation, as they needed a new facility. Waiting lines are manageable, but they are long when it comes to treatment of chronic pain.
The public healthcare fund ZZZS has already approved a new programme and Cugelj expects that the waiting times in this field will be completely eliminated in a few years.
STA, 27 December 2018 - The Constitutional Court has annulled the part of the health services act which stipulates that concessionaires should spend the surplus of revenue over expenditure for the performance and development of healthcare. The court agreed this encroached on the legal position of the petitioners and on their right to free business initiative.
The annulment, announced on Thursday, is related to the part of article 3 of the act which regulates the use of surplus generated by private companies and physicians with licenses to perform public healthcare services.
It says that public healthcare service "is being performed as a non-commercial service of general importance in a non-profit way, with the surplus of revenue over expenditure being spent on the performance and development of healthcare services."
The petition for the constitutional review of the act was filed by the Association of Private Practitioners and Dentists of Slovenia at the end of December 2017.
"This is only the beginning of a long period that will see us winning the battle in court and proving to the government that the concepts it advocates are not what the patients or those working in healthcare would deserve," the association's head Igor Dovnik said in response.
The Medical Chamber also welcomed the decision as confirming the provision harmed public services.
The chamber expects the court will also annul other contentious provisions in the act, in particular those limiting the scope of work for young doctors and for doctors employed both in private and public clinics, as well as provisions retroactively affecting already awarded concession licences.
As it received the petition, the Constitutional Court said that the provision limited the concessionaires and directly encroached upon the legal position of the petitioners.
The Constitutional Court said that the introduction in the national legislation of the term non-commercial service of general importance, which is a term in the EU law, did not mean that a public healthcare provider from the aspect of national law is no longer a non-commercial service.
"The term non-commercial public service under the Slovenian law is wider than the term non-commercial service of general importance under the EU law," the constitutional judges wrote.
When the amendments to the act were being adopted in parliament, reservations were also expressed by the parliamentary legal service, which wondered whether the definition of healthcare service as a non-commercial service of general importance was compliant with EU case law.
It had also noted that the Slovenian legal order did not define the term non-commercial service of general importance.
The Constitutional Court also assessed the provision from the aspect of the right to free business initiative, as it stipulates that public service should be non-profit and that surpluses from the operations should be kept in the public service.
"By preventing private entities from using the surplus from the activity for their personal needs, the legislator actually turned them into a non-profit legal form," it added.
"Limiting the freedom to dispose of the surplus very intensively narrows down the field of entrepreneurial freedom of private entities and encroaches upon their business initiative."
According to the court, such a measure is surely in the public interest to provide universal access to public healthcare services, but such an intensive limitation undermines one of the key incentives to perform the concession service.
As the reviewed encroachment upon the human right to free economic initiative outweighs the public benefit from it, the court has annulled the provision.
The association had also challenged article 42 of the act, which deals with the awarding of concessions and says that a concession is not a subject of inheritance, sale, transfer or any other form of legal transaction.
The court has ruled unanimously that the provision is not in violation of the Constitution. It said that a "concession to perform non-commercial public service is a right and not an authorisation in the sense of the law of obligations".
Asked by the STA to comment on the ruling, the Health Ministry said that it would comment once it received and examined the 26-page document.
STA, 11 December 2018 - Giving up on the National Institute for Congenital Heart Disease, which was scheduled to become operational in May this year, Health Minister Samo Fakin announced on Tuesday that the child heart cardiology programme would continue to be run by the UKC (Univerzitetni klinični center) Ljubljana hospital, albeit as part of a separate organisational unit.
The announcement comes a year after the government founded the National Institute for Congenital Heart Disease in response to a dysfunctional programme at Slovenia's main hospital.
While UKC, seeing a series of departures by surgeons and management staff involved in the programme in recent years, has been trying to make do with foreign specialists, the institute has failed to get off the ground, also being denied funding from the health purse operator ZZZS.
Tensions were also reported between UKC and the institute and the head of the institute's board Igor Gregorič resigned last week. The acting director Brane Dobnikar, who spoke last week of a blockade of efforts to get the institute going, also drew up a resignation statement.
Fakin told the press today that he would propose to the government to abolish the institute, which he expects will take a few months to process.
"I was assured at UKC that the programme is organised optimally and that young specialists were being secured in all categories," the minister said.
He noted that Slovenia would remain dependant on foreign experts, since 100 children with congenital heart disease are not enough to make the programme feasible logistically.
Fakin said efforts were under way to set up a regional centre, to also involve Croatia and Bosnia-Herzegovina.
"We were in Croatia yesterday and met with their health minister and heads of clinics and agreed we would have a talk after New Year's. They have 200 children, we have 100. If we include Bosnia, we can set up an internationally comparable centre and team," the minister announced.
UKC Ljubljana director-general Aleš Šabeder said that the first steps would already be made at the hospital next week towards establishing a new separate unit within UKC, which would combine the children's cardiology, heart surgery and intensive care units.
"I believe we've set up a stable system that can be upgraded into a well-functioning programme. It is presently still running with the help of hired specialists from neighbouring countries, but we expect younger specialists will join too. Relations are also better, stable," Šabeder said.
UKC medical director Jadranka Buturović Ponikvar explained that for now surgery on children in Ljubljana would be performed by domestic surgeons under the supervision of Czech surgeons from Prague's Motol hospital.
While praising the cooperation with Prague, Buturović Ponikvar noted that centres abroad also have staffing crises, which is why it is not good to rely only on one.
Following the announcement today, Fakin and Prime Minister Marjan Šarec met with the representatives of parents of children with congenital heart disease.
Talking to the press after the meeting, Petra Aleš expressed satisfaction that they ensured her that independent oversight, involving a foreign institution, would be introduced for the new programme.
"The oversight will allow parents to decide once and for all whether we can trust the programme," she said, adding that the parents regretted the decision to shut down the centre "but this story has ended and it's time to move on".
STA, 26 November - The international research project Implant Files has revealed that most Slovenian hospitals have no digital records on implants they put in patients. There is also no proper system of informing the Agency for Medicinal Products and Medical Devices on implant-related complications.
The only hospital in Slovenia with detailed digital records on all implants used is the Orthopaedic Hospital of Valdoltra in Ankaran, while other hospitals mostly still have them only in the paper form, including the National Institute of Public Health.
The digitalisation of medical data at Valdoltra started in the late 1990s and the hospital started building its own implant registry in 2002. According to the data from the ZZZS health insurance fund, the hospital conducted almost a quarter of all hip implant operations and almost a third of all knee replacements in Slovenia last year.
Statistical data show that there were no complications during most of the hip and knee surgeries, said journalists Anuška Delić and Maja Čakarić of the Oštro centre for investigative journalism in the Adriatic region.
But Delić and Čakarić warn that in Slovenia data on complications involving implants are difficult to find, as the system of reporting to the Agency for Medicinal Products and Medical Devices does not seem to be working properly.
In the last three years, the agency was notified of 258 complications related to implants and only 10% of these reports came from medical institutions, which are obligated by law to report to the agency within 24 hours after any complications.
In a response to the report, the agency said it was aware of the risks for patients, adding that as the competent body it had supervisory mechanisms at its disposal for the protection of health of Slovenian and EU citizens.
Its inspectors are performing supervision over producers and retailers and wholesalers of medicinal products and are overseeing their use in hospitals, healthcare centres, retirement homes and other institutions providing medical care.
The pharmaceutical inspection so far has not established major departures from the standards which would suggest that medicinal products on the Slovenian market are ineffective or pose a risk for users, the agency added.
It noted that the relevant EU regulations would be updated and enter into force in 2020, with the main advantages being better quality, safety and reliability of medicinal products and better transparency of information for consumers.
According to unofficial information, doctors more frequently report about problems to the implant manufacturers, although reporting to them is voluntary.
Data on implants by Valdoltra, UKC Ljubljana, UKC Maribor and the general hospitals of Celje, Jesenice and Novo Mesto show that more than half of the implant market in Slovenia is controlled by four big manufacturers: Zimmer Biomet, Johnson&Johnson, Stryker and Lima, the newspaper Večer reports in today's spread on the topic.
The 250 journalists from 36 countries participating in the research project found that 1.7 million injuries and almost 83,000 deaths in the last decade could be linked to implant fractures, decay, bending or other malfunctions. For Slovenia no such data is available due to poor record-keeping.
A national registry of implants should, however, be set up by Valdoltra as of next year. The hospital's current detailed records show that on average some 12% of hip implants and some ten knee implants have to be replaced a year.
Once the registry is completed, the data on implants will be available in an on-line application. According to the National Institute of Public Health, the digitalisation and the forming of the registry would cost EUR 30,000 and just as much should be spent annually for updating and maintaining the registry.
But for the time being, Valdoltra expects no additional costs as its existing staff is expected to work on the project.
The Implants Files international project website can be found here
STA, 23 November 2018 - The Ljubljana Institute of Oncology, which is celebrating its 80 anniversary this year, presented some of its main achievements on the occasion while it also took the opportunity to highlight the importance of preventive care.
The past eight decades saw the institute develop into the national oncology centre, which provides comprehensive care, while extensive research and education have made it one of the leading oncology centres in Europe, director general Zlata Štiblar Kisić told the press.
She explained the institute admitted 14,000 new cancer patients last year, conducting almost 110,000 examinations, 4,500 operations and 89,500 radiotherapies.
The institute organises the Dora and Zora preventive care programmes, which have helped reduce cancer incidence by half within ten years.
Medical director Viljem Kovač said that the share of patients cured successfully has risen to 60%, while major headway also continues to be made in the institute's research activities.
Maja Čemažar, assistant medial director for research and education, explained that the institute has almost 200 researchers, while she also highlighted its participation in European reference networks that allow it to send patients to leading European experts for consultation.
Also highlighted was the institute's breast surgery cooperation with the UKC Ljubljana clinic, which allows "Slovenian women to get the best reconstruction" and get it as part of the removal operation. 300 surgeries of this type are performed annually.
Štiblar Kisić said that 14,000 people in Slovenia get diagnosed with cancer each year. More than 100,000 have had some form of cancer at some point in their lives. 60% of the patients are older than 65.
The Oncology Institute marked its 80th anniversary with a ceremony on Sunday today, addressed by President Borut Pahor as the keynote speaker.
The institute’s English-language website is here
STA, 11 October 2018 - The National Bureau of Investigation (NBI) conducted searches of homes, companies and public hospitals on Thursday as part of an investigation into crimes committed in public procurement of stents. The investigation targeted ten individuals and two legal persons.
STA, 2 October 2018 - Samo Fakin, the new health minister, held his first meeting with hospital directors on Tuesday as he sets out to tackle the toughest issue under the purview of his portfolio, long hospital waiting times. He said he expected results within six months and indicated additional funding would be only a part of the solution.