Subject: Urgent Call for Support Regarding Healthcare Legislation and Workforce Crisis in Slovenia

Dear President of the European Commission, Mrs. Ursula von der Leyen,

We hope this message finds you well.

We are writing to inform you of a growing healthcare crisis in Slovenia, exacerbated by recently imposed and proposed legislative amendments and ongoing systemic challenges. These developments threaten both the quality of healthcare and the rights of medical professionals in our country. We feel like we have exhausted all domestic options for dialogue and negotiation as we turn to you for attention on the topic in desperation. Immediate action is required to prevent further deterioration of the situation, which could have serious consequences for both healthcare professionals and patients.

Recent Legislative Amendments

The Slovenian government has proposed significant amendments to the Healthcare Services Act (ZZDej), which directly affect the working conditions and operations of healthcare providers, particularly doctors. These amendments include:

1. Increased Centralization of Healthcare Management: The government now holds greater authority over the healthcare network, including the ability to dictate services and manage healthcare professionals across regions. Municipalities have been stripped of their influence on healthcare programs, which raises concerns about local healthcare needs being overlooked.
2. New Restrictions on Private Practice: Amendments have effectively limited the ability of healthcare professionals to engage in private practice (including freelance and additional working arrangements), reducing flexibility in service provision. There is a great violation of their right to work in comparison to other professions. This not only restricts the choices available to healthcare providers but also diminishes access to care for patients outside of the public system.
3. Increased Administrative Burden: The amendments introduce more stringent requirements for healthcare professionals, including an increase in documentation and reporting duties, which are expected to lead to additional administrative burdens without necessarily improving patient care.
4. Reduction of Local Autonomy: Local healthcare providers, especially those in smaller clinics, are increasingly unable to manage their services independently, making it more difficult to respond effectively to specific local needs.
5. Workforce Mobility and Employment: New employment conditions and restrictions on contractual arrangements further complicate the hiring and retention of staff, particularly younger healthcare professionals. These constraints, combined with bureaucratic hurdles, will discourage new doctors from entering the healthcare workforce. According to the new legislation, doctors will face significant restrictions when working simultaneously at more than one public healthcare institution. Physicians operating under public healthcare concessions will only be permitted to practice under their own name. This raises concerns regarding how they will secure substitutes in cases of illness or vacation.

Strike and its Context

Since January 15, 2024, Slovenia has witnessed the longest doctors’ strike in its history. The reasons for this unprecedented strike include the lack of action to address the systemic understaffing, heavy workloads, and inadequate compensation in Slovenia’s healthcare system. Additionally, the government had previously made a formal commitment to establish a separate salary structure for doctors by April 1, 2023; however, this has not been implemented until January 15, 2024, or even later on.

Moreover, the recent legislative amendments have further restricted doctors’ rights to strike by expanding the list of essential services they are required to provide, as well as mandating their presence at the workplace during strikes. This has led the Fides Union, representing doctors and dentists, to file multiple appeals to the Constitutional Court of Slovenia, challenging the constitutionality of these amendments and requesting a temporary suspension. However, the courts have so far not issued a ruling that addresses the doctors’ concerns.

Challenges to Workers’ Rights and European Law

The restrictions on the right to strike conflict with core European labor rights and international human rights standards. According to European Union labor laws and the Charter of Fundamental Rights, the right to strike is a protected measure for workers to advocate for fair conditions. The International Labour Organization (ILO) also emphasizes that workers’ right to strike is fundamental for negotiating improvements in working conditions.

By limiting the scope and impact of the strike through the recent amendments, the Slovenian government is undermining these rights, while also creating a situation where healthcare professionals are unable to take meaningful action in defense of their working conditions.

In addition to labor rights, the legislation potentially conflicts with EU competition laws by restricting private practice and limiting healthcare providers’ ability to operate independently.

Slovenia’s Alarming Healthcare Workforce Statistics

To highlight the magnitude of the problem, OECD healthcare workforce statistics provide a clear picture of Slovenia’s precarious situation. According to the data:

• Slovenia has 10% fewer doctors per capita compared to the OECD average.
• Despite this, our healthcare professionals handle 17% more hospital discharges than the OECD average.
• Slovenian doctors provide a comparable number of outpatient consultations, matching the OECD averages despite having a smaller workforce.

This gap indicates that our current healthcare workforce is overburdened, and any loss of professionals—through strike action, emigration, or burnout—would have devastating consequences for patient care.

 

Hate Speech from the Government and Media Propaganda

In Slovenia, doctors have increasingly been portrayed as the main culprit for the issues plaguing the public healthcare system, both in the aggressive rhetoric of the government and in the eyes of the public. Despite the government signing a written agreement with doctors‘ trade union in January 2023 stating the doctors were not to blame for the state of affairs in public healthcare. Many media outlets have contributed to this by consistently criticizing and deprecating doctors in their coverage, shaping public opinion against them. Notably, upon taking office, the health minister hired a PR agency, further intensifying concerns about the influence of media narratives on public perception.

 

Urgent Need for a Retention Strategy

Slovenia is not in a position to afford the loss of healthcare professionals. Instead of exacerbating the problem with restrictive legislation, the government should focus on workforce retention strategies that address doctors’ concerns and align with international best practices. Retaining healthcare professionals requires better working conditions, fair compensation, and respect for their right to advocate for these improvements through collective action.

Call for Action

In light of these issues, we urge the European Commission and WHO Europe to:

1. Monitor the situation and engage with the Slovenian authorities to ensure compliance with European labor laws and human rights standards.
2. Advocate for a dialogue between healthcare professionals, the government, and relevant stakeholders to resolve the crisis.
3. Support Slovenia in developing a sustainable healthcare workforce strategy that ensures quality patient care while protecting the rights of healthcare workers.

Your intervention is critical in ensuring that Slovenia’s healthcare system remains both functional and just. We look forward to your support in safeguarding healthcare professionals and patients alike.

 

Yours sincerely,

Mladi zdravniki Slovenije – Slovenian Junior Doctors

mladi.zdravniki.slo@gmail.com