**Abstract**

Achieving high quality in the provision of healthcare services represents a basic factor in meeting the healthcare needs of the individuals. Accessibility to health services in Slovenia over the last two decades has been presented according to some of the core values of quality and safety: performance, quality and patientcenteredness. The focus of the chapter is on three pillars of health system quality: structure, processes, and outcomes. In each part, we presented the standard practice and state of the art, but also the main achievements in the last decade. In the structural part, we highlight the investment in equipment and human resources and in the process part, the role of the primary level as a gatekeeper with the secondary and tertiary level. The results section concentrates on the measurement of the results in healthcare; the use of quality indicators and PROMs is discussed, the role of quality strategy and health technology assessment in the Slovenian healthcare system is presented.

**Keywords:** health-related quality of life, patient-centeredness, integrated care, strategy, structure, processes results, indicators

### **1. Introduction**

Basic motivation for healthcare system upgrading should be citizen's centeredness. By positioning citizen in the center, the whole chain of healthcare from promotion, prevention, and protection to diagnostics, treatment and rehabilitation is challenged to meet real healthcare needs of individuals. Immediate access to healthcare services with highest possible quality is crucial to achieve high health-related quality of life.

We decided to review provision of healthcare services in Slovenia in this millennium from the quality perspective. Considering performance, safety, timeliness, efficiency, equality and patient-centeredness as main values of quality and safety of healthcare system we projected them in the three pillars: structure, processes, and outcomes.

In the selection and description of the structural indicators, we aimed to highlight financing, equipment and human resources as the basis for physical accessibility – the availability of services enables the citizens to reach them within reasonable distance from home and within relatively short time. The analysis of the financing system presents the economic dimension acting as a support to physical accessibility and describes people's ability to pay for services without financial hardship.

With procedural indicators our focus was on the major processes in Slovenia which can act as good practices in the implementation of integrated healthcare

through a specific role of the primary level as gatekeeper and forming integrated care pathways with the secondary and tertiary level. Cases are presented which offered the solutions and supported the move of the healthcare towards more result-oriented system, such as accreditation process and introduction of RheumaHelper application.

The final part of the chapter concentrates on the measurement of the results in healthcare. Quality indicators and PROMs are presented; existing registries containing data on patients' health status, medical and case-mix variables that can serve as source to obtain useful information and ensure the baseline comparability of treatment populations and intervention factors. Quality strategy and status of health technology assessment is presented as well as a pilot project to implement outcome indicators through national tender.

Throughout the chapter we tried to objectively present the main structural, procedural and result-oriented developments and on the other hand, present the main achievement and implemented solutions in the last decade that are exceptional when evaluating them in the current moment with a critical time distance.
