Description of Project:

The Ministry of Health of Slovenia has commissioned a review and analysis of the health system from World Health Organization Regional Office for Europe (WHO) and The European Observatory on Health Systems and Policies (OBS) to:

— Inform the Minister on the performance of the health system;

— Assist the Government in gathering national and international evidence in order to identify possible reform options;

— Facilitate discussions around tentative reform options to be pursued with policy advisers.

The analysis will inform government policy on health expenditure and financing reform measures as well as on the optimization of the health services network. The government aims to develop, approve and implement reform measures to improve service delivery and efficiency in the health sector and to enhance the financial sustainability of the health system given growing costs and ageing demographics, while preserving and continuing to improve health outcomes.

The technical work for the project will identify key issues, and provide evidence on reform options and priority actions to improve the functions and structure of general public sector efficiency and performance. The analysis will also use administrative and facility-level datasets to examine patterns and trends in service delivery and identify opportunities for optimizing service delivery, so contributing to improving system efficiency and performance.

Project structure:

The project will consist of 5 evidence-generating Activities/work-programmes, with 1 team dedicated to each Activity:

— Activity 1: Fast track health systems review;

— Activity 2: Health system expenditure review;

— Activity 3: Assessment of health system funding;

— Activity 4: Purchasing and payment review;

— Activity 5: Optimizing service delivery: coordinated delivery at the primary-secondary and health and long-term care interfaces.

Each team will be guided by WHO/OBS and will include technical experts external to WHO-OBS, where necessary, with knowledge of and access to the data sources needed to support the analysis. The teams will be led by a Slovenian focal point and a WHO — OBS focal point. Each Activity work-programme will include a work-shop with relevant national experts and policy-makers to review and validate the draft findings and map tentative policy options.

In addition to the evidence-generating Activity work-programmes, the project will include a round of consultation with the Minister and Ministry of Health on key policy areas, as well as the organization of a set of Policy Dialogues that will present the evidence on priority topics and validate the findings of the evidence generating Activities.

The project has very tight deadlines for delivering outputs and will end on 31.12.2015.

Terms of Reference for International Expert: Assessment of health system funding.

The aim of Activity 3 is to provide an overview of options for funding of the health system in Slovenia. It aims to identify how more equitable and efficient funding systems could be designed to deliver quality healthcare services that are sustainable in the long term. The activity will draw heavily on the experiences of other countries.

We are seeking a highly qualified senior health policy analyst who will:

1) Collect evidence and analyse options for reforming various dimensions of health care financing, including:

i) Strengthening public sector revenue generation and pooling: The analysis will discuss the options for improving the reliability and sustainability of the system of public financing for health in Slovenia. This section will describe key characteristics and consequences of current public financing arrangements, and will review the pros and cons of alternative approaches to collecting and pooling public revenues, drawing on international evidence and experiences. The analysis will focus on the potential for increasing revenues from existing sources (including but not limited to payroll taxes) and diversifying funding by identifying new sources of funding, in an effort to increase the level and reliability of resources. The analysis will also investigate the factors that contribute to gaps between health system revenues and expenditures, such as the heavy reliance on payroll tax revenues, vulnerability to economic cycles and shocks, high level of unemployment and changing demographics; inequities in the burden of funding; and the division of financing between the private and public sectors.

ii) Reconsidering the benefits package: The analysis will consider the range of services covered within the health system and — particularly in light of cost pressures — evaluate the appropriateness of the benefits basket and the extent to which private financing arrangements are equitable or sustainable.

iii) Reassessing the role of voluntary health insurance: The analysis will describe voluntary health insurance in Slovenia and review its impact on health system performance in terms of equity, efficiency (including strategic purchasing and administrative costs) and financial protection. The analysis will consider possible alternative roles for voluntary health insurance, drawing on international evidence and experience.

2) Undertake a mapping exercise on: The sustainability of long-term care.

The analysis will review current methods for financing long-term care and explore alternative approaches to sustainable funding for long-term care based on compulsory public insurance and other social benefits. It will examine the scope for better coordination of resources, expanded tax-based financing or the introduction of specific contributions for long-term care provision, and will assess options for managing out-of-pocket payments.

3) Produce a Final Report consisting of 2 parts:

Part I on health system financing in Slovenia and the options for funding diversification, incorporating the evidence and analysis under (1) above; and

Part II — Mapping of long-term care financing issues.

The Report will be developed in 2 stages:

i) a preliminary draft used for verification of findings, consultation and review (July 2015); and

ii) a final Report (October 2015).

4) The international expert will attend all necessary consultation workshops and/or Policy Dialogues associated with evidence gathering, analysis and finalization of the Report. In particular, two site visits to Slovenia are anticipated — 1 in July and 1 in October 2015.

5) The international experts will co-operate with the focal points of the project's other Activities, in particular, to facilitate information exchange between work programmes.

It is expected that the work will take place over (about 25) working days over a period ending on 31.12.2015.