Evaluation of an Early Individualized Integrated Rehabilitation Program versus Standard Rehabilitation Program for Smoking Cessation in 115 Smokers Among 467 Female Breast Cancer Patients 2019-2021 in Slovenia.

BACKGROUND Cigarette smoking affects cancer risk and cardiovascular risk. Smoking cessation is very beneficial for health. This study aimed to evaluate an early individualized integrated rehabilitation program and standard rehabilitation program for smoking cessation in breast cancer patients. MATERIAL AND METHODS This prospective study included 467 breast cancer patients (29-65 (mean 52) years of age) treated at the Institute of Oncology Ljubljana from 2019 to 2021 and were followed longer than 1 year. The control group and intervention group included 282 and 185 patients, respectively. Three questionnaires were completed by patients before and 1 year after the beginning of oncological treatment. The intervention group received interventions according to the patient's needs, while the control group underwent standard rehabilitation. The data obtained from the survey were analyzed using the chi-square test and analysis of variance. RESULTS In total, 115 patients were tobacco smokers before the beginning of cancer treatment. There were no differences between the intervention and control group in the prevalence of smoking before the treatment. Before the cancer treatment, smoking was present in the intervention group in 22% and in control group in 27% (P=0.27). One year after the beginning of cancer treatment, smoking was present in the intervention group in only 10% of cases, while it was present in control group in 20% of cases. Smoking was significantly less common in the intervention group than in the control group (P=0.004). CONCLUSIONS Smoking cessation was more common after early integrated rehabilitation than after standard rehabilitation.

Human Resource Planning in Health Care: Outlining a Basic Model and Related Complexities.

The effectiveness of the health care system is largely dependent on the knowledge, skills, and motivation of health care workers, which was particularly evident during the COVID-19 pandemic. The systemic planning of human resources is therefore an important condition for ensuring the sustainability and efficiency of the health care system. This article focuses on outlining a basic model of human resource planning in health care and the investigation of related complexities. An in-depth analysis framework based on various materials and evidence is proposed in order to outline the factors that influence human resource planning in health care. In order to achieve greater credibility of the research results, the in-depth analytical process employs an extensive review of the literature and carries out an investigation of numerous sources and materials, in both the national and international contexts. The purpose of the human resource planning initiatives in health care is to calculate the needed number of health care workers in the future, on the basis of past and current data, and based on assumptions about future trends in supply and demand. The research findings reveal that this is a very challenging task, as there are typically many unknowns in future planning, and, in addition, planners often face a lack of reliable data and systemic deficiencies. Moreover, the study indicates that unplanned and delayed solutions concerning the human resource needs in health care can only alleviate problems, but in no way can they replace effective strategic measures and timely structural changes within the health care ecosystem.

Slovenia: Health System Review.

This analysis of the Slovene health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Slovenia has a statutory health insurance system with a single public insurer, providing almost universal coverage for a broad benefits package, though some services require relatively high levels of co-insurance (called co-payments in Slovenia). To cover these costs, about 95% of the population liable for cost-sharing purchases complementary, voluntary health insurance. Health expenditure per capita and as a share of GDP has increased slightly, but still trails behind the EU average. Among statutory health insurance countries, Slovenia is rather unique in that it relies almost exclusively on payroll contributions to fund its system, making health sector revenues vulnerable to economic and labour market fluctuations, and population ageing. Important organizational changes are underway or have been implemented, especially in prevention, primary, emergency and long-term care. Access to services is generally good, given wide coverage of statutory health insurance. Further, Slovenia has some of the lowest rates of out-of-pocket and catastrophic spending in the EU, due to extensive uptake of complementary voluntary health insurance. Yet long waiting times for some services are a persistent issue. Though population health has improved in the last decades, health inequalities due to gender, social and economic determinants and geography remain an important challenge. There is variation in health care performance indicators, but Slovenia performs comparatively well for its level of health spending overall. As such, there is clear scope to improve health and efficiency, including balancing population needs when planning health service volumes. Recently, the Slovene health care system was overwhelmed by the demand for COVID-19-related care. The pandemicâs longer-term effects are still unknown, but it has significantly impacted on life expectancy in the short-term and resulted in delayed or forgone consultations and treatments for other health issues, and longer waiting times. Additional challenges, which are necessary to address to ensure long-term sustainability, strengthen resiliency and improve the capacity for service delivery and quality of care of the health system include: 1) health workforce planning; 2) outdated facilities; 3) health system performance assessment; and 4) implementation of current LTC reform.

Slovenia: Health System Review.

This analysis of the Slovene health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the population has improved over the last few decades. While life expectancy for both men and women is similar to EU averages, morbidity and mortality data show persistent disparities between regions, and mortality from external causes is particularly high. Satisfaction with health care delivery is high, but recently waiting times for some outpatient specialist services have increased. Greater focus on preventive measures is also needed as well as better care coordination, particularly for those with chronic conditions. Despite having relatively high levels of co-payments for many services covered by the universal compulsory health insurance system, these expenses are counterbalanced by voluntary health insurance, which covers 95% of the population liable for co-payments. However, Slovenia is somewhat unique among social health insurance countries in that it relies almost exclusively on payroll contributions to fund its compulsory health insurance system. This makes health sector revenues very susceptible to economic and labour market fluctuations. A future challenge will be to diversify the resource base for health system funding and thus bolster sustainability in the longer term, while preserving service delivery and quality of care. Given changing demographics and morbidity patterns, further challenges include restructuring the funding and provision of long-term care and enhancing health system efficiency through reform of purchasing and provider-payment systems.

Slovenia: health system review

This analysis of the Slovene health system reviews recent developmentsin organization and governance, health financing, health care provision,health reforms and health system performance. The health of thepopulation has improved over the last few decades. While life expectancyfor both men and women is similar to EU averages, morbidity and mortalitydata show persistent disparities between regions, and mortality from externalcauses is particularly high. Satisfaction with health care delivery is high, butrecently waiting times for some outpatient specialist services have increased.Greater focus on preventive measures is also needed as well as better carecoordination, particularly for those with chronic conditions. Despite havingrelatively high levels of co-payments for many services covered by the universalcompulsory health insurance system, these expenses are counterbalanced byvoluntary health insurance, which covers 95% of the population liable forco-payments. However, Slovenia is somewhat unique among social healthinsurance countries in that it relies almost exclusively on payroll contributionsto fund its compulsory health insurance system. This makes health sectorrevenues very susceptible to economic and labour market fluctuations. A futurechallenge will be to diversify the resource base for health system funding andthus bolster sustainability in the longer term, while preserving service deliveryand quality of care. Given changing demographics and morbidity patterns,further challenges include restructuring the funding and provision of long-termcare and enhancing health system efficiency through reform of purchasing andprovider-payment systems.

Decision-making criteria among European patients: exploring patient preferences for primary care services.

BACKGROUND: Health economics preference-based techniques, such as discrete choice experiments (DCEs), are often used to inform public health policy on patients' priorities when choosing health care. Although there is general evidence about patients' satisfaction with general-practice (GP) care in Europe, to our knowledge no comparisons are available that measure patients' preferences in different European countries, and use patients' priorities to propose policy changes. METHODS: A DCE was designed and used to capture patients' preferences for GP care in Germany, England and Slovenia. In the three countries, 841 eligible patients were identified across nine GP practices. The DCE questions compared multiple health-care practices (including their 'current GP practice'), described by the following attributes: 'information' received from the GP, 'booking time', 'waiting time' in the GP practice, 'listened to', as well as being able to receive the 'best care' available for their condition. Results were compared across countries looking at the attributes' importance and rankings, patients' willingness-to-wait for unit changes to the attributes' levels and changes in policy. RESULTS: A total of 692 respondents (75% response rate) returned questionnaires suitable for analysis. In England and Slovenia, patients were satisfied with their 'current practice', but they valued changes to alternative practices. All attributes influenced decision-making, and 'best care' or 'information' were more valued than others. In Germany, almost all respondents constantly preferred their 'current practice', and other factors did not change their preference. CONCLUSION: European patients have strong preference for their 'status quo', but alternative GP practices could compensate for it and offer more valued care.

Slovenia: health system review

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Life expectancy in Slovenia has improved since 1993, reaching 78.5 years in 2007. This value is comparable to those of other European Union (EU) Member States (those belonging to the EU prior to 2004, plus those joining the EU on 1 May 2004 (EU25)), but slightly below the average of the EU MemberStates before the enlargement of May 2004 (EU15) and significantly above the respective average value of the countries that joined the EU in May 2004 and January 2007 (EU12). Health care services in Slovenia are financed mainly bycontributions to compulsory health insurance, premiums for voluntary health insurance (VHI) and through taxes. Although entitlement to health care services is universal in Slovenia, access to some health care services is limited due to lack of providers (for example, dental care) or long waiting times (for example, for certain operations). Health care services at the primary level are provided mainly by state-owned primary health care institutions as well as by independent general practitioners (GPs). Providers of primary health care act as gatekeepers for specialist services. Slovenia’s health care system has undergone major changes since the countryachieved independence in 1991. This momentum of constant change was retained during the period from 2002 to 2007 and was based on a white paper published by the Ministry of Health and on the World Bank project “A Management Model or Health Care”. Reform policy during this period included, inter alia, reform of health care financing (for example, payment for hospital services is now based on diagnosis-related groups (DRGs)); introduction of clinical guidelines by the Ministry of Health to increase quality of health care; cancellation of compulsory insurance (Health Insurance Institute of Slovenia (HIIS)) debts; and subsequent introduction of a convergence programme to limit HIIS expenditure. Furthermore, a risk-equalization scheme for VHI was introduced in 2005, which aims to reduce cream-skimming between voluntary health insurers and to equalize the variations in risk structure between private health insurance companies.