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Diabetes control strategy and action plan adopted

Partner Institute: 
Institute of Public Health of the Republic of Slovenia, Ljubljana
Survey no: 
(15) 2010
Tit Albreht
Health Policy Issues: 
Public Health, Prevention, New Technology, Pharmaceutical Policy, System Organisation/ Integration, Quality Improvement, Benefit Basket, Access, Responsiveness
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no


After a long discussion within the medical profession and adjustments made with other national strategies (esp. on nutrition and physical activity) the Health Council finally adopted the National Diabetes Control Strategy and the related Action Plan. This sets ground for a new approach to diabetes management in Slovenia, including specific measures ranging from public health to rehabilitation. Consensus has been reached across the different fields involved on how to address diabetes control.

Purpose of health policy or idea

The action plan on diabetes involves four main goals:

  1. reduction of the prevalence of diabetes type 2,
  2. prevention and/or delay of the development of  diabetes type 2 in high risk   individuals
  3. early detection of diabetes
  4. reduction of the frequency of complications and mortality due to diabetes.

Processes that will lead to these four goals are the following:

  1. Patient empowerment
  2. Co-ordination of health care across different levels and providers involved in diabetes management
  3. Follow-up on diabetes management and of the carrying out of the national programme
  4. 4. Partnerships development

Main points

Main objectives

Diabetes is a chronic disease that affects around 125,000 people or 6.25 percent of the total populationin Slovenia. Of these 53,000 individuals are treated with oral therapies, around 16,000 are treated with insulin only and 10,500 patients rare treated with combined therapies. The costs of these medications reached around 20 million Euro in 2007 (6.5 percent of the total pharmaceutical expenditures) and the costs of medical aids for diabetic patients were around 13.5 million Euro (30 percent of the total expenditure on medical aids). 60 percent of the costs of diabetic care are direct costs and add up to 15 percent of the total health expenditure.

There has been a renewed interest in diabetes management lately. Reasons for such an interest were the following:

  1. Rising incidence and prevalence of diabetes as a result of negative lifestyle developments, especially obesity.
  2. Diabetes as one of the diseases that is fully reimbursed by the compulsory health insurance - as a consequence high expenditures on its management.
  3. Technological advances in diabetes management leading to ulterior increases in expenditures.
  4. Rearrangement of responsibilities for the management of patients in the system - clearer distinction of stepwise approaches and responsibilities by the health care system level.
  5. Adoption of national guidelines for diabetes management, which served as an outline of delivery of care for diabetic patients.

Type of incentives

Most of the incentives are financial as they are closely related to the management of a disease that, according to estimates of the International Diabetes Federation, consumes around 15 percent of the total health insurance budget in Slovenia. Incentives are directed at early detection and treatment of diabetes, at its prevention and at involving patients in all steps of diabetes management.

Groups affected

Diabetic patients, Health Insurance Institute of Slovenia, Health care providers

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low very high very high
Transferability strongly system-dependent rather system-neutral system-neutral

Political and economic background

There has been a long process of preparation of three important and interlinked documents:

  1. National guidelines on diabetes management
  2. National programme on diabetes management
  3. Action plan on diabetes

This has been the complete framework supplemented already in 2005 by the National strategy on nutrition and physical activity. As this strategy is approaching its final months, it was important to translate it into another nationally relevant strategy and plan.

Obviously, as diabetes is a rather 'costly' disease to be successfully managed, there were financial interests in trying to better control these expenditures. Reaching an important share - 15 percent - of the total health expenditure, there is always room for improvement in terms of optimisation.

Change based on an overall national health policy statement

National Program for Diabetes Control and Action Plan for Diabetes Control

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Origins of health policy idea

The need for a structured policy approach to diabetes care has been present in the health policy discussions for around two decades. Since diabetes care is fully reimbursed by the compulsory health insurance, there was less pressure on the patient side for additional programmes. That still did not relieve the burden of certain complex decisions regarding diabetes care from the decision makers. Furthermore, as diabetes care is fully reimbursed, the new programmes and interventions were even more scrupulously scrutinised. Additionally, as the strategy on nutrition and physical activity was adopted in 2005, it became necessary to include interrelations between that strategy and diabetes care in the overall management at the national level. And since 2010 is the last year of the duration of the present strategy there is a need to evaluate its impact on different health problems. Moreover, since the adoption of the Patients' Rights Act, there is an additional obligation of involving patients in all phases of a disease management programme.

If Slovenia wants to continue providing a rather generous package for the care of diabetic patients, a better insight into the different aspects of care is required. This insight must include the assessment of the total costs, expenditures, lost lives and disability related to the disease as well as the impact on the health care system and health insurance.

Initiators of idea/main actors

  • Government

Approach of idea

The approach of the idea is described as:

Stakeholder positions

The initiator of the National Programme and Action Plan on Diabetes is the Ministry of Health (MoH). Consensus exists regarding the importance diabetes should play in the allocation of resources and research funding, as well as on the necessity to develop solutions to reduce the disability caused by diabetes. That is why all the key stakeholders involved in the process are supportive of the approach and took part in designing the national programme and the action plan.

Actors and positions

Description of actors and their positions
Health Insurance Institute of Sloveniavery supportivesupportive strongly opposed
Health care providersvery supportivesupportive strongly opposed
Diabetic patientsvery supportivevery supportive strongly opposed

Influences in policy making and legislation

There will be no formal piece of additional legislation since the national programme and the action plan represent the two key documents which express committment on behalf of the government (who adopted these documents!) and not only on behalf of the MoH.

Legislative outcome


Actors and influence

Description of actors and their influence

Health Insurance Institute of Sloveniavery strongvery strong none
Health care providersvery strongstrong none
Diabetic patientsvery strongstrong none
Diabetic patientsHealth care providersHealth Insurance Institute of Slovenia

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Expected outcome

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable system more equitable system more equitable
Cost Efficiency very low high very high


Sources of Information

Nacionalni program za obvladovanje sladkorne bolezni: Strategija razvoja 2010-2020 (National program for diabetes control: Strategy of development 2010-2020). Ministry of Health of Slovenia, November 2009.

Akcijski naèrt za obvladovanje sladkorne bolezni (Action plan for the diabetes control). Ministry of Health, February 2010.

Slovenske smernice za zdravstveno oskrbo oseb s sladkorno boleznijo tipa 2 (Slovenian guidelines for the health care of patients with diabetes type 2). Association of endocrinologists of Slovenia and the Clinic for endocrinology, diabetes and metabolic diseases of the University Clinical Centre of Ljubljana, 2007.

Author/s and/or contributors to this survey

Tit Albreht

Suggested citation for this online article

Albreht T. "Diabetes control strategy and action plan adopted". Health Policy Monitor, April 2010. Available at