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Maks Tajnikar and Petra Došenovicˇ Boncˇa
The 2005 changes in the health insurance legislation reveal: • The alternatives of maintaining capital-funded insurance and implementing risk equalization have to be carefully considered when reforming VHI for full copayment coverage. The capital-funded insurance alternative has important positive macroeconomic effects and enables the flexible and modern operation of health insurers. Conversely, risk equalization involves the development of a complex administrative system that can often have unpredictable repercussions on the voluntary health insurance market. • The principle of intergenerational mutuality coupled with risk equalization does not necessarily create conditions in which competition works properly. Risk equalization, introduced to an unbalanced market structure, could increase market concentration and decrease competition. • A risk-equalization scheme alone does not improve voluntary health insurers’ ability to alleviate the ever-increasing burden on public compulsory health insurance or their ability to staunch the cumulative losses of compulsory health insurance. • Risk equalization, if not implemented in the right circumstances, can create unintended effects. These conclusions also imply that the recently proposed legislation does not comprehensively address the key issue of the inappropriate role and place of voluntary health insurance within Slovenia’s health care system. There are two solutions: • The size and scope of compulsory health insurance have to be changed in order to develop types of private health insurance that are truly voluntary in nature. • Because the newly proposed legislation does not comprehensively address the issue of the inappropriate role and place of voluntary health insurance, it can be understood only as a transitional arrangement for voluntary health insurance in Slovenia.
Reforming the Size and Scope of Compulsory Health Insurance To develop types of private health insurance that are truly voluntary in nature, the size and scope of compulsory health insurance have to be changed. This is necessary not only because it opens up new possibilities for the development of voluntary health insurance but also because it is a way to resolve the problem of the losses compulsory health insurance has accumulated in the past. An excessively broad definition of the list of services guaranteed by compulsory health insurance limits possibilities for other types of voluntary health insurance to develop. The 2005 legislation took an important initial step in redefining the compulsory insurance benefits package. In principle, this is in line with providing