In January 2024, Slovenian Government made significant changes to the Health Care and Health Insurance Act. The biggest change is that the health insurance is now fully managed by ZZZS and that there is no longer any supplementary health insurance. Instead of supplementary health insurance, a new compulsory health insurance contribution of EUR 35,00 per month has been introduced. The changes in the law and the structure of health insurance impacts all health services, as well as coverage of costs for medicines and foodstuffs. Until January 2024, the costs for medicines and foodstuffs were covered by compulsory (OZZ) and supplementary health insurance (DZZ), depending on which list the medicine or foodstuff was classified. Expenses for medicines on the P70 list were covered on average 70,00% from the funds of the OZZ, while expenses for medicines and foodstuffs from the V list were covered on average 10,00% from the OZZ, and the rest had to be paid either out of pocket (by the patients) or from the premium of the supplementary health insurance. As a result, the withdrawal of the DZZ and the transfer of the entire health insurance institution into the hands of the ZZZS brought many changes and novelties. This thesis focuses on most interesting changes in the coverage and classification of medicines and foodstuffs.
The objective of this master's thesis was to evaluate the impact of the withdrawal of supplementary health insurance on the consumption and financing of medicines and foodstuffs on the P70 and V list of medicines. Next, from the published data on the number of medicines prescribed, the number of boxes issued, the number of prescriptions prescribed and the total value of prescriptions, we examined the consumption of medicines and foodstuffs by lists (P, P70 and V). In addition, we looked at the classification of drugs by ATC groups and focused on selected cases of drugs that were classified and on the positive and on the V list. We looked at the financial part of the drug payment-coverage and the two main sources of payment: OZZ and DZZ (together with co-payments).
The central part of the master's thesis was the projection of financial stability of OZP contributions for the period from 2024 to 2028. Methodologically, the analysis was carried out on the basis of data and information gathered from annual reports of ZZZS and private insurance companies. On the basis of previously known data, such as the number of insured, the total value of prescriptions, the calculated 10-year growth coefficients and the net revenues of private insurance companies, we have made a projection of ZZZS revenues and expenses in the next five years. We have prepared and analyzed three scenarios, and in each we took into account different growth coefficients for the total value spend for prescriptions.
With our analysis, we gained better insight into the financial future of the ZZZS when it comes to paying contributions and covering medicines and foodstuffs. Finally, we estimated the OZP contributions over the next five years which will be needed for the entire health insurance system to remain sustainable.
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