3.4 Out of pocket payments
OOP payments in Slovenia take the form of both cost-sharing and direct payments (see also section 3.2).
3.4.1 Cost-sharing (user charges)
Co-payments were introduced by the Health Care and Health Insurance Act 1992 as part of the compulsory health insurance system. They apply to most types of health care service and, since 2007, to all patients with the exception of children and students until the age of 26 plus some vulnerable groups, such as unemployed individuals, those with income below a certain threshold and chronically ill people (breadth of coverage is also discussed in section 3.3.1). Co-payment levels are set out in Article 23 of the Act, and are defined by the HIIS on a regular basis; they range between 10% and 90% depending on type of treatment or activity (see depth of coverage in section 3.3.1). As mentioned above, the vast majority of compulsorily insured individuals purchase complementary VHI policies to cover co-payments. In the (rare) event that the patient does not have such a policy, the difference up to the full price of health services has to be paid to the provider directly. Otherwise the provider charges the respective VHI company.
3.4.2 Direct payments
Direct OOP payments at the point of use are required for goods and services that are not covered by any form of insurance. These occur for visits to primary care physicians and private providers who do not have a contract with the HIIS, along with specialist services without GP referral and private dental services. Patients may also choose to pay directly for covered services to avoid waiting times, or to pay for services not included in the benefits package of the compulsory insurance scheme, such as special hospital (“hotel”) services or better food. Certain services, such as cosmetic plastic surgery or eye laser correction surgery, are not included in any health insurance packages and have to be paid fully out of pocket. There is no exact information available as to the share of total expenditure contributed via direct payments made by patients (Cylus, 2015).
3.4.3 Informal payments
Informal payments are not common in the Slovene health system. They occur in kind or in cash to health care providers, predominantly in primary care and for outpatient services. As the phenomenon is not widespread, they are not observed as a separate category but are included in OOP payments, and estimated by questionnaires.