Slovenia
In Slovenia EHFCN has one member:
ZZZS – Health Insurance Institute of Slovenia
Health Insurance Institute of Slovenia (HIIS)
Zavod za zdravstveno zavarovanje Slovenije (ZZZS)
The Health Insurance Institute of Slovenia was founded on 1 March 1992 and conducts its business as a public institute, bound by statute to provide compulsory health insurance.
The Institute’s principal task is to provide effective collection and distribution (allocation) of public funds, in order to ensure the insured persons quality rights arising from the said funds. The rights arising from compulsory health insurance, furnished by the funds collected by means of compulsory insurance contributions, comprise the rights to health care services and rights to several financial benefits (compensation of lost salary during temporary absence from work, reimbursement of travelling expenses related to implementation of health care services, long-term care).
The Institute is governed by an Assembly, whose members are the (elected) representatives of employers (including the representatives of the Government of the Republic of Slovenia) and employees. The executive body of the Assembly is the Institute Board of Directors.
In 2020, of the total compulsory health insurance budget, the Institute designated a sum of approximately 2,3 billion EUR for health care services, 388,6 million EUR for medication, 82,8 million EUR for medical devices, 8,4 million EUR for vaccines and 446 million EUR for various financial benefits. This amounts refer to the expenditure of (public) funds, collected on the basis of contributions paid by employers and employees, and by several other categories of contributors.
| Priority | Action Areas | Category | Example |
|---|---|---|---|
| 1 | Action | Compliance to regulations | All types of action once fraud is detected |
| 2 | Medical Check | Avoid waste/overconsumption | Overutilization of services – no medical evidence |
| 3 | Prevention | Compliance to regulations | Both soft and hard |
| 4 | Detection | Compliance to regulations | Data access, legal aspects, tools, .. |
| 5 | Financial Check | Avoid waste/overconsumption | Overly expensive services |
