What can you do if you are one of the 144,496 people who have been left without a general practitioner?

So, as an individual, what can you do if you are left without a general practitioner? Taking into account the time and energy available to you, you currently have four options:

If you have waited too long to choose a general practitioner and you are already ill and in need of immediate medical attention, your only option is to go to the emergency room. 

ER is an option since an insured person can claim emergency treatment and urgent medical care without a referral. If the notoriously long waiting times at Ljubljana’s ER make you lose your mind, the public health system also allows you to be examined and treated by a psychiatrist without a referral.

If you want to choose a general practitioner before you get sick and need his or her medical services, on the website of the Health Insurance Fund you can check the list of all general practitioner clinics in each regional unit of the Health Insurance Fund still accepting new patients. The list is updated three times a month.

As of 20 December 2022, data shows that there is only one general practitioner working at the University Medical Centre Ljubljana and one general practitioner working at Ljubljana’s Primary Health Care Centre (»ZD«), as well as three general practitioners with a concession. If this does not suit you, 24 general practitioners within a 30-kilometre radius are accepting new patients. 

Although you might not have issue with the fact that your chosen general practitioner’s surgery is not in your hometown, it is worth noting that your chosen general practitioner is not obliged to »accept« this. The Rules on Compulsory Health Insurance (»POZZ«) allow him or her to refuse an insured person if, taking into account the distance between your residence and the general practitioner’s surgery, he or she would not be able to offer or provide all the services for which they are registered.

As a last resort, if you are young and healthy, you can go to a medical clinic outside the public health network (known as a self-pay clinic) and pay approximately EUR 50 out of your own pocket for your first check-up with a general practitioner. However, this amount will not be reimbursed by the ZZZS. The POZZ provides that »an insured person is not entitled to reimbursement of the costs of medical treatment, including medicines, medical-technical devices and transport, if the medical services were provided in a private clinic«. 

A general practitioner in a private clinic will be able to give you a referral (after a paid examination) for treatment at secondary or tertiary level in the public healthcare network. However, he or she will not be able to issue you with a sick note for work, which is a requirement for the payment of sick pay by the ZZZS.

Given this cutback in primary health care, it is legitimate to think that this kind of health care payment system has done away with your right to freely choose your doctor. The aforementioned POZZ provision has placed you in the absurd position of having to pay the full price for the services of a doctor outside the public health network, even though you have paid the compulsory insurance contributions.

In my view, the disputed provision of the POZZ is in contravention of the Health Care and Health Insurance Act (»ZZVZZ«), as the latter does not discriminate between clinics in the public health care network and those outside it. Unlike POZZ, ZZVZZ guarantees the right to payment for health services for everybody equally. However, the Supreme Court of Slovenia takes a different view. In its landmark judgment No. VIII Ips 273/2017 of 15 May 2018, it took the view that »the Slovenian regime is based on the provision of health services in-kind and does not provide for the reimbursement for the health services claimed at the primary level«. Several insured persons challenged that judgment before the Constitutional Court, which found that this issue does not violate human rights or fundamental freedoms that would have serious consequences for the appellant, nor was there an important point of constitutional law that went beyond the merits of the specific case. It, therefore, did not uphold their constitutional complaint for review (Up-1023/18 of 29 June 2020).

Since 2020, you can no longer rely on the Slovenian judiciary to deal with your problems related to the shortage of general practitioners, as the judiciary is no longer dealing with them. The only remaining court is the Court of Justice of the European Union, which is competent to assess whether the Slovenian healthcare system guarantees us the right to medical care under Article 35 of the Charter of Fundamental Rights of the European Union in practice, in accordance with the conditions laid down by Slovenian law. 

The Slovenian courts’ understanding that compulsory health insurance only guarantees the right to in-kind health services from providers in the public health network is significantly narrower than the current legal text, which speaks of a general right to payment for health services. To paraphrase, this distinction is similar to the Slovenian courts reducing the right to annual leave allowance under the current labour law to the right to spend annual leave at the holiday accommodation of one’s employer.

The latest option to tackle the shortage of general practitioners are recently opened »outpatient clinics for the undesignated«. These are supposed to be for patients without a general practicioner who need non-urgent medical care.

Author:  Katja Triller Vrtovec, Attorney-at-Law