FINANCING HEALTH CARE SYSTEMS IN THE SELECTED COUNTRIES AND COMPARING TYPES OF HOSPITAL FINANCING

Tematika financiranja zdravstvenih sistemov je v zadnjih letih postala zelo aktualna predvsem zaradi naraščajočega obsega zdravstvenih izdatkov in je čedalje bolj predmet razprav in reform v številnih državah, predvsem v smislu uvajanja ukrepov za povečanje ekonomske učinkovitosti. Namen in cilj magistrske naloge je preučiti in predstaviti financiranje zdravstvenih sistemov v Sloveniji, Avstriji, na Nizozemskem in Švedskem ter predstaviti dobre prakse iz tujine, ki bi jih lahko implementirali v slovenski zdravstveni sistem. Dodaten raziskovalni izziv je bil tudi primerjati načine financiranja bolnišnične dejavnosti, ki v Sloveniji predstavlja največji delež izdatkov v zdravstvu. Rezultati raziskovanja so pokazali, da je slovensko zdravstvo najbolj finančno podhranjeno v primerjavi s primerjanimi državami, saj namenimo le 8,6 % od BDP za zdravstveni sistem, medtem ko Švedska nameni največji delež med primerjanimi državami: kar 11 % od BDP. Načini financiranja zdravstvenega sistema se v primerjanih državah razlikujejo po višini prispevkov, ki so zakonsko postavljeni in tudi po sami ureditvi celotnega sistema. Najbolj očitna razlika med slovenskim zdravstvom in Avstrijo, Nizozemsko ter Švedsko je v centraliziranosti zdravstva, medtem ko je v primerjanih državah zdravstveni sistem decentraliziran na regije in lokalno samoupravo. Za financiranje bolnišnične dejavnosti poznamo več načinov, ki se delijo glede na vrsto planskih postavk (retrospektivni, prospektivni in kombinirani sistemi) ali glede na razmerje med financiranjem in realiziranim delovnim programom (neomejen ali omejen sistem). Za Slovenijo, ki ima trenutno urejeno financiranje s skupinami primerljivih primerov, bi bil ustrezen kombiniran sistem, kjer bi poleg plačevanja po utežeh posameznih skupin primerljivih primerov bolnišnice dobile plačane tudi pomožne storitve, ki niso zdravstvene.The topic of financing health systems has become very important in recent years, mainly due to the increasing volume of health expenditure, and is increasingly the subject of discussions and reforms in many countries, especially in terms of introducing a measure to increase economic efficiency. The purpose and goals of the master’s thesis are to examine and present the financing of health systems in Slovenia, Austria, the Netherlands, and Sweden, and to present good examples from abroad that could be implemented in Slovenian health system. An additional research challenge was also to compare the financing methods for hospitals, which represents the largest share of health expenditure in Slovenia. The result of the research showed that Slovenian health care is the most financially malnourished compared to the countries that we compared since only 8.6 % of GDP is allocated for the health system, while Sweden allocates the largest share among the countries compared: as much as 11% of GDP. The methods of financing health care system differ in the countries compared with the number of contributions, which are legally set up and they also differ in the organization of healthcare systems. The most obvious difference between Slovenian healthcare and Austria, the Netherlands, and Sweden is in the centralization of health care while in the countries compared, the health system is decentralized to regions and local self-government units. There are several ways to finance hospitals and they are divided according to the type of plan items (retrospective, prospective, and combined systems) or depending on the relationship between financing and the realized program (unlimited and limited systems). For Slovenia, which currently has funding for groups of comparable cases, it would be an appropriate combined system where hospitals would also receive payment for auxiliary and non-medical services in addition to paying for the weights for individual groups of comparable cases