**3. Financial and coverage overview**

In 2018, public expenditure on healthcare in Slovenia amounted to 5.8% of GDP (gross domestic product) [4]. Over the last 10 years (**Figure 1**), the evolution of public expenditure on health reflects the fluctuations related to the adoption of certain measures and the economic cycle, but during this whole period, it remained at around 6% of GDP. The same is true for total current health expenditure, which reached 7.9% of GDP in 2018, the lowest level in the last 9 years, which is also below the EU average of 8.4 % of GDP [1, 4, 5]. Existing policies have been successful in maintaining spending levels, but there have been problems with the financial performance of public health facilities, and waiting times have increased, worsening the accessibility of health services [1, 5].

#### **Figure 1.**

*Health expenditure by financing scheme, in % of GDP, 2005–2018. Source: Institute for Macroeconomic Analysis and Development, 2019 [5].*

### *Complementary Health Insurance in Slovenia DOI: http://dx.doi.org/10.5772/intechopen.105150*

Expenditure on VHI amounted to 1.2% of GDP in 2018, while it increased by about 0.1–0.3% of GDP between 2009 and 2018. Total health expenditure by functions and sources of funding in Slovenia (2006-2019) is shown in **Figure 2**. Complementary health insurance is an additional source of funding for the health system, as much as 95% of the population is enrolled. According to the Health Care and Health Insurance Act (Article 23), most health services involve high copayments for most of the population. Only certain diseases, children, and young people under 26 years of age enrolled in school are fully covered by compulsory health insurance. The risk of copayments is hence very high [1].

Since 1992, the share of copayments has gradually increased due to a lack of public funding, especially during the last economic crisis. The income-independent single premium is the largest weakness of complementary health insurance in the system. This means that the system is regressive, although it should be supported by income solidarity given the high risk of copayments. In 2016, for example, the annual premium was equivalent to 62% of the net monthly minimum wage, 33% of the average net wage, and 57% of the average net pension [4, 6]. The regressive nature of this source was significantly reduced in 2012 when new social legislation introduced the automatic transfer of user fees from the state budget for welfare recipients. This benefit had already been introduced in 2009, but until 2012, it was not automatically linked to eligibility for social assistance [1].

Almost every permanent resident of Slovenia is entitled to the health benefits covered by compulsory health insurance either as a contributing member or as a dependent person (e.g., children). Opting out is not possible. Permanent residence is one of the most important factors for defining entitlement to health benefits, but Articles 15–18 of the Health Care and Health Insurance Act [7] set additional conditions under which a person is compulsorily insured [1, 2, 8].

According to the available data, 2,116,739 people were compulsorily insured in 2019, representing more than 99% of the population [1, 9]. About 0.14% (3345) people were uninsured at the end of 2020 [1, 9]. Most of them were temporarily
