The European Journal of Public Health Advance Access originally published online on January 23, 2006
The European Journal of Public Health 2006 16(3):237-242; doi:10.1093/eurpub/cki224
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Transition in Eastern Europe |
Changes in primary health care centres over the transition period in Slovenia
Tit Albreht1, Diana M. J. Delnoij2 and Niek Klazinga3
1 Institute of Public Health of Republic of Slovenia, Trubarjeva 2, SI-1000 Ljubljana, Slovenia
2 Nivel—Netherlands Institute of Health Services Research, Drieharingstraat 6, PO Box 1568, 3500 BN Utrecht, The Netherlands
3 Academic Medical Centre, University of Amsterdam, Meibergdreef 9, NL-1105AZ Amsterdam Zuidoost, The Netherlands
* Correspondence: Tit Albreht, Institute of Public Health of Republic of Slovenia, Trubarjeva 2, SI-1000 Ljubljana, Slovenia, tel: +386 1 244 14 20, fax: +386 1 244 15 30, e-mail: tit.albreht{at}ivz-rs.si
Background: Primary health care centres (PHCCs) were a characteristic of the former Yugoslav health care system introduced widely in Slovenia. Transition brought structural changes to health care and the position of the PHCC's was challenged. This paper investigates (i) PHCCs' perception of transition changes in health care, (ii) changes in resources and services, and (iii) changes in the relationships between PHCCs and new primary health care providers. Methods: We mailed a self-administered questionnaire with 42 questions divided into 8 chapters and related to the period between 1990 and 2000 to all 65 PHCCs in Slovenia. Questions were of three types, grouped according to the aspects we were trying to explore: perceived changes, actual changes and relations with new providers. Results: We obtained 57 questionnaires representing PHCC catchment areas covering 93.7% of the Slovenian population. Municipalities' position versus PHCCs was reinforced but their role remains ambiguous. The number of employees was reduced by one third, capital investments are still ongoing, but the scope and volume of services has shrunk. Relations with the Health Insurance Institute of Slovenia (HIIS) were considered controversial while the influence of the public providers' association is perceived as marginal. Conclusions: PHCCs have survived the transition both structurally as well as functionally. However, an unstructured approach to system changes in primary care, a poorly managed process of introducing private provision, and a monopoly position of the HIIS affected their situation. The challenges for the future will be in preserving their public health functions, in increasing efficiency and in establishing clearly defined relations with private providers.
Keywords: transition in health care, primary care, private provision