|Implemented in this survey?|
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.
The action plan on diabetes involves four main goals:
Processes that will lead to these four goals are the following:
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:
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.
Diabetic patients, Health Insurance Institute of Slovenia, Health care providers
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
There has been a long process of preparation of three important and interlinked documents:
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.
National Program for Diabetes Control and Action Plan for Diabetes Control
|Implemented in this survey?|
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.
The approach of the idea is described as:
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.
|Health Insurance Institute of Slovenia||very supportive||strongly opposed|
|Health care providers||very supportive||strongly opposed|
|Diabetic patients||very supportive||strongly opposed|
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.
|Health Insurance Institute of Slovenia||very strong||none|
|Health care providers||very strong||none|
|Diabetic patients||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|
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.