|Implemented in this survey?|
The cancer professional community and policymakers spent a lot of time developing a comprehensive cancer control plan and it was long overdue. Between June and September 2008 (with a later extension until the end of 2008!) there was an open public debate. Later, during 2009 additional consultations on the Plan took place. The final version is to be adopted by the Health Council by the end of 2009. This would enable enactment of certain programs and activities already in 2010.
These are the main goals of the National Cancer Control Plan:
These goals are expected to be achieved through several measures that are to be taken. They include activities in the field of primary prevention, secondary prevention, diagnostics and specific oncologic treatment, integral rehabilitation, palliative care, education, informatics, cost efficiency, participation of the civil society and coordination and control.
In order to advance the current situation to a higher level, it will also be necessary to clearly define criteria of cancer care for professionals and for providers (hospitals and diagnostic centres). These should include the minimum quantitative and qualitative requirements for these centres to be able to carry out cancer care. What needs to be stressed as one of the most important problems of the present situation is the lack of these criteria. Consequently, providers too often 'compete' in trying to get a number of cancer care programmes included in their annual contracts simply because this care is rather costly.
Primary prevention will focus on the promotion of healthy lifestyles, which have benefits for other chronic non-communicable diseases. On the other hand, advances are expected in addressing the use of tobacco and alcohol. In the field of secondary prevention the most important effort will be in supporting cancer screening programmes which should lead to higher percentages of early detectable cancers, especially cervical cancer, breast cancer and colon cancer. Following the criteria mentioned above, it will become a priority to define the relevant institutions for cancer care, where concentration and development of resources as well as sufficient turnover of patients are achieved to ensure cost-effective, high quality and safe cancer care. These efforts will be supplemented by the development of research and education as well as through the involvement of the civil society representing the different patient groups within the cancer field.
These are the main objectives of the National Cancer Control Plan (NCCP):
The NCCP is supposed to provide the professional base for interventions at all levels that would lead towards the fulfilment of the goals mentioned above.The main advantage of the Plan is supposed to be its comprehensiveness over the previous partial activities related to the different locations of cancer in the human body.
There should be the following incentives:
Cancer patients, Cancer professionals, Health Insurance Institute of Slovenia
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
The Slovenian NCCP is not an innovative document but it brings important structured knowledge to decisionmakers, who need to take decisions regarding each of the proposed elements. This includes in particular: screening programmes, policies related to new and innovative drugs for cancer and to the definition of reference and treatment centres for each or the principal cancers. In the case of cancers with a small incidence, the NCCP is pretty clear about requring centralisation of such specific cancers.
Preparations of the NCCP have been intense over the period of 10 years. A change of government that took place in 2008 was an indirect stimulus for the speeding up of this important goal. The team preparing the Plan focused on:
The economic background has not been evaluated in total. But it is estimated that the present approaches result in a fragmented service, which is rather costly and above all inefficient. Therefore, one of the most important proposals in the organization of cancer care is in the concentration of services in selected verified and strictly quality-controlled centres. Such an approach has already been used to structure and reorganise screening programmes for cervical and breast cancer (also see HPM 11/2008, "Launch of screening for breast and colon cancer").
Resolution of the National Health Plan 2008-2013
|Implemented in this survey?|
There has been a long process leading to the adoption of the present National Cancer Control Plan (NCCP). Cancer in terms of its management and financing occupies a particular place in the Slovenian healthcare system. It is a disease the management of which is fully covered by compulsory health insurance. This includes prevention, screening, diagnosis, treatment, rehabilitation and palliative care. For this reason there has been less pressure because of additional costs of treatment. On the other hand, there were problems in access to early diagnosis, certain types of treatment and also delays in the introduction of the recent screening programmes for breast and colon cancer.
There have been divergent interests in cancer management across different types of providers. Due to the negotiation process between the Health Insurance Institute of Slovenia and representatives of different categories of providers, there was an exaggerated incentive in a race for treatments of more complex patients, among them cancer patients. This has led to deviations, such as setting up of mammography centres in small hospitals without adequate staff and eventually screening women who would normally not fulfil guideline inclusion criteria for screening. Sometimes discontinuity in patient treatment or disease management was observed. The National Institute of Oncology was faced with advanced diagnostics of false positive patients on inadequately performed screening tests.
Health policy ideas were therefore linked to:
The NCCP was initiated both by the policymakers in health care and by the cancer community. The latter was trying to achieve a more equitable distribution of providers of cancer care, while at the same time quality control criteria should ensure that the quality of care provided by a qualified provider would be according to national standards. All screening programmes should be centrally managed and monitored and closely linked to the national cancer registry. The Slovenian National Cancer Registry is one of the oldest institutions of its kind in Europe and even in the world as it was established back in 1950 and has been running in continuation ever since.
The approach of the idea is described as:
renewed: Inspired by policy actions in other countries, such as the UK, Sweden
The idea of adopting a NCCP was generally seen as positive and as a step forward by all relevant stakeholders and it was not facing specific objections. The main problems related to its adoption and expected implementation were related to:
|Ministry of Health||very supportive||strongly opposed|
|Health Insurance Institute of Slovenia||very supportive||strongly opposed|
|Cancer patients||very supportive||strongly opposed|
|Cancer care professionals||very supportive||strongly opposed|
The main formal output is the document, the NCCP itself. It will serve as the base for action according to its clearly defined elements. Public discussion regarding this document has produced a lot of useful feedback, which has been incorporated or taken account of in the preparation of the final version of the document.
The main controversy among providers was related to the concentration of influence and also delivery of care among a few selected providers. As much as this is clearly a rational move, it has brought some negative feedback to the document, often for the loss of influence in the treatment of patients with a serious and publicly visible disease.
|Ministry of Health||very strong||none|
|Health Insurance Institute of Slovenia||very strong||none|
|Cancer patients||very strong||none|
|Cancer care professionals||very strong||none|
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
This Plan will provide a sound base for: