The evolution of community-based primary health care, Slovenia

PROBLEM: Slovenia’s model of primary health care relied on reactive, episodic care and was ill-equipped to address the country’s burden of disease dominated by noncommunicable diseases. APPROACH: The government has developed a multidisciplinary, community-based, prevention-oriented service delivery model for primary health care. A compulsory family medicine residency programme was introduced in 2000, and from 2004 screening and control of chronic diseases were established in family medicine practices. Health promotion centres were established, providing group interventions to support healthy lifestyles. After 2011, registered nurses were introduced to conduct screening for chronic diseases, provide counselling and manage patients with stable noncommunicable diseases. LOCAL SETTING: In 1992, the government transformed Slovenia’s health financing scheme to a social insurance system based on mandatory payroll taxes. The system enabled private provision of health services, although primary care was mostly provided by publicly funded community health centres. A strong gatekeeping role was introduced. RELEVANT CHANGES: Despite spending less on health than the European Union (EU) average, by 2013 Slovenia’s life expectancy was higher than the average for EU countries. The increase was due in part to rapidly declining infant and under-five mortality and a faster decline in premature mortality due to chronic diseases. LESSONS LEARNT: Slovenia’s approach was enabled by strong public health and governance structures, along with accountability mechanisms that monitored outcomes and took corrective action when necessary. New programmes were piloted, creating a strong evidence base that facilitated obtaining sustainable financing, while national roll-out was supported by regional branches of the National Institute of Public Health.