Financiranje sistema zdravstvenega varstva na temelju solidarnosti in socialne pravičnosti

magistrsko delo Management v zdravstvu in socialnem varstvu

Špela Klemenčič (Author), Neva Maher (Mentor), Eva Zver (Co-mentor)

Abstract

Zaradi demografskih in družbenih sprememb ter hkrati zaradi omejevanja javne porabe zaradi finančne krize, ki je prizadela Evropo po letu 2008, se (javni) sistemi zdravstvenega varstva v mnogih državah na svetu soočajo z velikimi finančnimi negotovostmi, ki imajo pomemben vpliv na doseženo raven dostopnosti in kakovost zdravstvenih storitev (Sklepi Sveta o skupnih vrednotah in načelih zdravstvenih sistemov Evropske unije, 2006). Številni sistemi ne uspejo zajeziti rasti stroškov, finančni pritiski pa vse bolj otežujejo zagotavljanje socialnega in zdravstvenega varstva v posameznih državah v Evropi in izven njenih meja (EK, 2011). V Sloveniji se že od nastopa globalne ekonomske krize soočamo z velikimi negotovostmi ne zgolj na področju finančne vzdržnosti sistema zdravstvenega varstva, temveč tudi na drugih področjih družbenega delovanja in razvoja. Kriza je razkrila številne strukturne pomanjkljivosti v državi, pogoste odmike je zaslediti v obstoječi regulativi, z vidika finančne vzdržnosti javnih sistemov in obstoja sistema blaginje pa je vse prej kot ugodna tudi demografska struktura in napovedi za prihodnost. V nalogi smo predstavili trenutno stanje in gibanje trendov posameznih postavk, ki so neposredno povezane z zagotavljanjem zadostnih in stabilnih virov financiranja sistema zdravstvenega varstva (javni in zasebni viri financiranja, davki in socialni prispevki) ter v okviru le-teh proučili obseg solidarnosti in socialne pravičnosti. Na osnovi teoretičnih spoznanj, primerjalnih podatkov, kvalitativne analize in matematičnih izračunov smo v zaključnem delu naloge ocenili vpliv trenutne ureditve na izbrane kazalnike solidarnosti in socialne pravičnosti (to so univerzalen dostop, progresivnost in proporcionalnost, pokritost za osnovno košarico pravic, stopnja delitve stroškov različnih družbenih skupin v sistemu obveznega zdravstvenega zavarovanja, višina premije pri dopolnilnem zdravstvenem zavarovanju, delež neposrednih plačil iz žepa) ter nakazali možnosti nadaljnjega razvoja. Financiranje sistema zdravstvenega varstva v Sloveniji ni pravično in vpliva na zmanjšanje načela solidarnosti. Breme financiranja sistema prevzema predvsem aktivna populacija, obstoječa ureditev ob predpostavki demografskih sprememb pa tudi ne zagotavlja finančne vzdržnosti sistema na dolgi rok. Kljub trenutnim fiskalnim omejitvam, je nujno potrebno pretehtati javne prihodke in znotraj le-teh iskati stabilne vire za financiranje sistema zdravstvenega varstva, ki bodo zadostili predvsem zdravstvenim potrebam prebivalstva kot tudi številnim drugim zahtevam v sistemu in izven njega. Da bi zagotovili solidarnost in socialno pravičnost na ravni zbiranja sredstev za financiranje sistema zdravstvenega varstva so potrebne usklajene politike na vseh ključnih področjih družbenega delovanja in razvoja kot tudi usklajeno delovanje vseh ključnih funkcij znotraj sistema zdravstvenega varstva, ki so medsebojno povezane in soodvisne. Dostopnost do učinkovitih zdravstvenih storitev in zaščita pred zdravstvenimi in/ali dohodkovnimi šoki se lahko uresničuje zgolj s sodelovanjem in podporo, skrbno načrtovanimi procesi in aktivnostmi, visoko pokritostjo za definiran obseg storitev (standard, obseg in cene zdravstvenih storitev bi morale biti regulirane) ter transparentno in odgovorno rabo sredstev na vseh nivojih delovanja (razdelitev sredstev glede na dejanski obseg opravljenih storitev z upoštevanjem nagrajevanja za kakovostno opravljeno delo). Zgolj na tak način lahko spodbujamo enakost in pravičnost v sistemu ter izboljšujemo kakovost življenja prebivalcev in prebivalk, ki je pomemben dejavnik blaginje in osrednji cilj družbenega razvoja.

Keywords

sistemi zdravstvenega varstva;shema financiranja;prispevki za zdravstveno zavarovanje;

Data

Language:	Slovenian
Year of publishing:	2018
Typology:	2.09 - Master's Thesis
Organization:	UM FOV - Faculty of Organizational Sciences
Publisher:	[Š. Klemenčič]
UDC:	614.2
COBISS:	8067347
Views:	1105
Downloads:	161
Average score:	0 (0 votes)
Metadata:

Other data

Secondary language:	English
Secondary title:	Funding of health care system based on solidarity and social justice
Secondary abstract:	of public budget restrictions following the financial crisis that has affected Europe in 2008, (public) healthcare systems in numerous countries around the globe are facing considerable financial uncertainties, which has a significant impact on the achieved level of availability, scope, and quality of healthcare services (Council Conclusions on Common values and principles in European Union Health Systems, 2006). Various systems are struggling to contain cost growth, while financial pressures make it increasingly challenging to ensure social security and healthcare provision in individual states of the EU and beyond (EC, 2011). Since the onset of the global economic crisis, Slovenia has been facing increased instabilities, not only in terms of financial sustainability of the healthcare system but also in other areas of social organisation and development. The crisis has uncovered many structural weaknesses in the country, in existing regulations there are frequent deviations, while in terms of financial sustainability of public systems and of the welfare system, the demographic structure and the predictions for the future are also proving to be less than favourable. The thesis presents the current state and the development of trends of individual items that are directly connected to the provision of sufficient and stable sources of healthcare funding (public and private funding sources, taxes, and social contributions) and, further, examines the scope of solidarity and social fairness in this context. Based on theoretical insights, comparative data, qualitative analysis, and mathematical calculations, the concluding part of the thesis assesses the impact of the current arrangement on selected indicators of solidarity and social fairness (namely, universal access to healthcare, progressivity and proportionality, basket of basic healthcare rights, the cost-sharing rate between different social groups in the compulsory health insurance system, premium levels in supplementary health insurance, rate of direct, out-of-pocket payments) and identifies potential prospects for future development. Healthcare funding in Slovenia is not fair and adversely impacts the principle of solidarity. Considering the demographic and social changes, this threat to the principle of solidarity, which is already becoming the new reality, is expected to continue to grow in the following years. Nevertheless, in current circumstances of fiscal restraint, there is an urgent need for a re-examination of public revenue to find stable resources of financing the (public) healthcare system that will meet healthcare needs of the population as well as respond to numerous other demands in and outside of the system. In order to ensure solidarity and social justice on the level of collecting funds for the healthcare system, we need consistent and coordinated policies in all key areas of social organisation and development as well as coordinated action of all key functions within the healthcare system. This is the only way to build the welfare system, encourage equality and justice within the system, and improve the quality of life for all, which is a major determinant of welfare and the main goal of social development.
Secondary keywords:	healthcare systems;financing schemes;contributions for health care;supplementary health insurance;taxes;out-of-pocket payments;
URN:	URN:SI:UM:
Type (COBISS):	Master's thesis/paper
Thesis comment:	Univ. v Mariboru, Fak. za organizacijske vede
Pages:	125 f.
ID:	10962607