This article is more than 5 years old. Information may no longer be current.
Meeting increasing demand for intravitreal injections next goal of ophthalmology in Slovenia
Despite the economic downturn, the government has been asked to allocate resources for reimbursement of ranibizumab and aflibercept.
Click Here to Manage Email Alerts
Slovenia, a country with a long tradition of high medical quality, is currently facing the challenge of funding and organizing high volumes of intravitreal procedures to maintain the standards that patients expect.
“Numbers are growing fast. Last year we performed 6,000 injections, and we expect to do about 20% more this year. We have efficient screening programs, diagnose patients early and immediately send them to treatment. We like to respect schedules and regimens and don’t want delays. This requires a considerable effort in terms of organizing care,” Marko Hawlina, MD, PhD, FEBO, president of the Slovenian Society of Ophthalmology, said.
Although off-label Avastin (bevacizumab, Genentech) was used in the past, the government has been asked recently to make a bigger financial effort to allow the use of the approved drugs Lucentis (ranibizumab, Genentech) and Eylea (aflibercept, Regeneron).
“It’s a considerable investment in drugs, but if we want to give our patients the best of care, we need a higher number of paid procedures and more staff,” Hawlina said.
Marko Hawlina
Full coverage for patients, low salaries for doctors
Health care in Slovenia is provided free to patients through a single state-owned insurance company. The current economic downturn has produced a contraction in the gross domestic product, and a further negative rise of 1% is expected this year. Although health expenditure has become an increasing burden, the general rule in Slovenia is that patients should never be affected.
“Reimbursement for procedures is getting increasingly lower, and the salaries of doctors are falling more and more below the standards of other comparable professionals. However, we would never question the right of patients to continue having the best standards of treatment and to have it for free,” Hawlina said.
With 120 ophthalmologists serving a population of 2 million people, Slovenia is one of the countries with the lowest doctor per patient ratio in Europe. However, dedication, motivation and ethics are strong in the medical profession.
“We are facing an increasing work overload and also cover all the basic refraction procedures, as we do not have optometrists. We work long hours but manage to maintain efficiency and to keep waiting times quite low for all procedures,” Hawlina said.
Approximately 70% of ophthalmologists are employed in the public sector, which encompasses two university hospitals in Ljubljana and Maribor, five regional hospitals in other major cities and a number of community health centers for outpatient care evenly distributed within the country. The other 30% of eye doctors work in private centers but offer national insurance-paid services to patients.
“The only procedures that are paid by patients out of pocket are refractive surgery and cataract surgery with premium IOLs. If patients want a multifocal or a toric, they have to pay for the entire procedure,” Hawlina said.
Striving for quality
Hawlina said that the free market has not truly reached the medical profession in his country. The public system of salaries, with a basic low pay and no incentives, in addition to the presence of one centralized national insurance system and no private insurances, is giving little incentive to private enterprise.
“Also, those colleagues who work in private practices have a quota of patients they can treat per year under national insurance coverage, so there is no interest in increasing patient volume and expanding practices quantitatively. However, we invest a lot in high-tech equipment to keep the quality high, also in the private sector,” he said.
Striving for quality and continuous updates has allowed Slovenia to keep up to the standard of western European countries. The education and training programs for medical students and ophthalmology residents and fellows provide high levels of knowledge and expertise. Many of the young ophthalmologists take the European Board of Ophthalmology examination in Paris every year with excellent results. Foreign languages, particularly English, but also German and Italian, are part of schools’ curricula and are commonly spoken at a good level by most of the population. All of this has contributed to Slovenia remaining competitive through years of socialism and the post-socialist transition.
“We had a socialist system but were never locked in and were able to maintain freedom of communication and scientific exchange,” Hawlina said.
The presence of Slovenian ophthalmologists, therefore, has been always quite high at international meetings. In more recent years, the capital city, Ljubljana, has hosted the meetings of several international societies and offered locally organized meetings and courses of international interest.
“We also receive many guests from neighboring countries who come for training,” Hawlina said. “Over the years, we have gone through a process of increasing integration and communication with the most developed centers in the EU and continue going the good way.” – by Michela Cimberle