Study Tour Report February 2019.Pdf
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Regional Study Tour 2019 PRIMARY HEALTH CARE 28th January – 1st February 2019 FINAL REPORT TETRAS d. o. o. Dorjan Marušič Contents 1 Background .............................................................................................................................. 3 1 Objectives of the Study Tour ................................................................................................... 4 2 Program ................................................................................................................................... 5 3 Slovenia – background ............................................................................................................. 7 4 Activities ................................................................................................................................ 12 4.1 Introduction.................................................................................................................... 12 4.2 Meeting at Ministry of Heath ......................................................................................... 13 4.3 Meeting at Health insurance Found............................................................................... 19 4.4 Meeting at Primary Health Care Centre Sevnica ........................................................... 20 4.5 Meeting at Primary Health Care Centre Ljubljana ......................................................... 22 4.6 Wrap up .......................................................................................................................... 25 5 Actors ..................................................................................................................................... 27 6 Conclusions ............................................................................................................................ 28 7 Annex - list of presentations .................................................................................................. 29 7.1 PPT for introduction ....................................................................................................... 29 7.2 PPT form HIF ................................................................................................................... 37 7.3 PPT from PHC Sevnica .................................................................................................... 42 7.4 PPT from PHC Ljubljana .................................................................................................. 48 7.5 PPT at wrap up ............................................................................................................... 53 1 Background The Swiss Development and Cooperation (SDC) invests in Albania, Bosnia and Herzegovina and Kosovo in the health sector – in the frame of its respective Swiss Cooperation Strategies. Most of the Swiss health interventions are supporting the primary health care level of the public health system. Community mental Health care, nursing, integrated care; multi-sectoral health promotion and prevention are other important aspects of the Swiss portfolio in the Balkans. The regional health advisor has in its function to organize and foster regional exchange and learning among the three programs. This year a study tour shall allow getting insight into a similar but advanced system through a study tour in Slovenia and exchange on the selected topics among the participants. Some basic reflections for a strategic paper on the future orientation of the Swiss health engagement could be another result of this exchange. 3 1 Objectives of the Study Tour The objective of the Study Tour is to learn from a country in the region that is a member state in the European Union- how it tackles the most pressing public health issues of its population. The participants shall get an understanding of the following aspects: 1. The Public Health System in Slovenia (roles and responsibilities of the different actors, Structure and Financing, decentralization level, regulation) including Public and Private sector 2. The Health care services at Primary Health Care level with the following aspects: Role of nurses and doctors, management structures, quality assurance, Health Information System/Data, home based care models and dealing with demographic change 3. The organization and functioning of the integrated care model in remote and urban areas 4. Health Promotion and Prevention – system in place, financing, results Members of the delegation: • Maja Zarić • Merita Mustafa • Bernhard Soland • Liliane Tarnutzer • Zhenihen Zanaj and • Debora Kern. Organizers: • Dorjan Marušič, expert, Tetras • Martina Marušič, koordinatorka ? Tetras • Marša Marušič, oblikovalka ?, Tetars Tu dajta blj fancy vsebine dela 4 2 Program MONDAY, 28.1.2019 as planed Arrival GRAND HOTEL UNION BUSINESS, Miklošičeva cesta 3 19.00 Dinner with briefing RESTAURANT ŠESTICA, Slovenska cesta 40 Presentor: DORJAN MARUŠIČ TUESDAY, 29.1.2019 9.00–10.45 INTRODUCTION to Slovenian Health System, Demogra- GRAND HOTEL UNION BUSINESS, meeting room phy and Burden of Disease Presentor: DORJAN MARUŠIČ 11.00–13.00 MEETINGS AT THE MINISTRY OF HEALTH – MINISTRY OF HEALTH, Štefanova ulica 5 The Public Health System in Slovenia (roles and responsibilities of MoH, Structure and Financing, decentralization level, regulation) including Public and Private sector Presentors: TANJA MATE, director Directorat for health care MOJCA ČINČ GODEC, director Directorat for public care 13.00–14.00 Lunch DETERMINED ON SITE 14.00–15.30 MEETINGS WITH HEALTH INSURANCE FUND – HEALTH INSURANCE FOND (ZZZS), Miklošičeva cesta 24 The Public Health System in Slovenia (roles and responsibilities of HIF, Structure and Financing, decentralization level, regulation) Presentor: BORIS KRAMBERGER 19.00 Dinner TO BE DETERMINED WEDNESDAY, 30.1.2019 8.30 Departure from hotel GRAND HOTEL UNION BUSINESS 10.00–12.30 MEETING AT PHC SEVNICA – PRIMARY HEALTH CARE CENTER SEVNICA Role of nurses and doctors, management structures, quali- ty assurance, Health Information System/Data, home based care models and dealing with demographic change. Presentor: VLADIMIRA TOMŠIČ 5 12.30–13.00 Coffee break SEVNICA 13.00–15.00 MEETING AT PHC SEVNICA – PRIMARY HEALTH CARE CENTER SEVNICA The organization and functioning of the integrated care model in remote and urban areas Presentor: VLADIMIRA TOMŠIČ 15.00–18.00 Social event SEVNICA THURSDAY, 31.1.2019 9.00 MEETING AT PHC LJUBLJANA – PHC LJUBLJANA, Metelkova ulica 9 The organization and functioning of the integrated care model in urban areas AND Role of nurses and doctors, management structures, quality assurance, Health Infor- mation System/Data, home based care models and deal- ing with demographic change. Presentor: RUDI DOLŠAK 11.00 Wrap up GRAND HOTEL UNION BUSI- NESS, Presentor: DORJAN MARUŠIČ meeting room 13.00 Lunch DETERMINED ON SITE 16.00–18.00 INTERNAL SDC WORKSHOP on input paper Health in the GRAND HOTEL UNION BUSI- NESS, WB All SDC staff Meeting room 19.00 Dinner with all presenters DETERMINED ON SITE FRIDAY, 1.2.2019 as planed Departure GRAND HOTEL UNION BUSI- NESS 6 3 Slovenia – background Number of inhabitants (2016): 2.1 million GDP p.c. (2016): 24 100 EUR PPP Life expectancy and health level 2016: 81.3 years (M: 78.2, F: 84.3). Health life years expectancy at birth: F: 57.9.2 and M: 58.7 years. 67% of Slovenians report to be in good health. Causes of mortality: Although mortality rates from both cancer and cardiovascular diseases have fallen since 2000, they remain above the EU average, and for men they are actually among the worst in Europe. External causes represent the third largest group of deaths for men and rank fifth for women, mainly because of the high numbers of falls, mostly in old age, in both groups and suicides. In 2014, Slovenia ranked fourth in terms of mortality from suicide in the EU, with particularly high levels among men and large regional disparities between western and eastern Slovenia. Risk factors: In 2014, 19% of adults in Slovenia smoked tobacco every day, which is slightly below the EU average and down from 24% in 2001. Obesity rates, however, are above the EU average and for adults have increased from 16% in 2007 to 19% in 2014. What is more, 20% of 15-yearolds were either overweight or obese in 2014, the fifth highest level in the EU, with boys particularly affected. This is despite reporting above average levels of physical activity. An important contributor seems to be the deteriorating diet of Slovenian adolescents in recent years. Slovenians appear to have some of the worst dietary behaviour in the EU with less than one in three eating fruit and vegetables regularly, more than one in three consuming sugar-sweetened beverages regularly and every second child skipping breakfast. Slovenians also have the second highest level of salt intake in the EU, an important contributor to the fact that a quarter of the population had high blood pressure in 2014. Repeated drunkenness among 15- year-olds is higher than in most EU countries, but binge drinking among adults is close to EU average. The alcohol consumption among adults is 11.5 litres in 2015. Total health expenditures (THE): In 2015, Slovenia spent EUR 2 039 per head on health care, compared to the EU average of EUR 2 797. This equals 8.5% of GDP, which is also below the EU average of 9.9%. However, its health system is one of the most expensive among the newer Member States. Only 71.1% of health spending is publicly funded compared to 78.7% at EU level. However, only 13% of private health expenditure