Slovenia first in Europe to launch national electronic health care card

Ljubljana 03 November 2000Since October 1st, Slovenia has introduced a personal electronic health care card for all its 1,9 million inhabitants. This card has the primary function to check out whether the patient has a health insurance right. The electronic health care record infrastructure of the Slovenian republic, which constitutes a former part of the federal state of Yugoslavia, seems principally inspired on previous plans, as conceived by DSW, a Dutch health insurance organisation. Slovenia is the first European country to have succeeded in the creation of a national health care card at relatively short notice.

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Once having obtained its independence, Slovenia soon started to carry out its plans for a national health care card. The chip cards provided with Pin security are primarily intended to verify whether the patient has a health insurance. The roll-out of an official health care card means a major step forward for the Slovenian public health service. Previously, the entire health administration was paper-based with a booklet in cardboard for each Slovenian. Both employers and health care providers were charged with a permanent task of copying, stamping and changing data by hand.

From October 1st on, the paper booklets are no longer valid and patients are obliged to use the electronic health care card. Each health care provider and every medical institution has a legal obligation to work with the new health care card. The ICT-architecture has been developed mainly by Siemens and Gemplus. Each Slovenian health care taker has been provided with a Health Care Professional Card for identification. General practitioners, pharmacists, and hospitals have been installed with a PC, including a card reader and two slots, one for the care providers and one for the patient. Only when a health care taker introduces a card, the information on the patient card is decoded.

The Slovenian electronic health care card is the answer to the administrative overload and the financial slump. In the past, many premiums simply could not be cashed. Approximately 30 percent of the treatments remained unpaid since patients were insufficiently identified. An additional factor constitutes the regular health care shopping in the fairly modern republic of Slovenia by patients from relatively pauper neighbouring countries, like Bosnia, Croatia, and Rumania. These patients tend to utilise the names of Slovenian relatives and friends.

The electronic health care card does not include any medical data. The chip only carries personal details as well as information on health care insurance, organ donation and the regular health care provider. Medical data will only become available on the Slovenian health care card at a later stage, in which a more rigid authorisation will be executed by Trusted Third Parties and PKI encryption, using Public Key Infrastructure. The insertion though of medical functions on the health care card is considered unrealistic by the Slovenian public health service, at least for now.

At present, plans are studied on how to use the chip card's multi-functional capacity. Probably, in the long run, the card will serve as a key to provide access to medical data in computer databases. This has caused somewhat of a shock in Slovenia, particularly in the legal department where a certain fear exists for restricted authorisation mechanisms as to prevent temporary health care personnel from access to personal patient data. No initiative has been taken so far to provide the Slovenian health care card with information for Social Security Services.

The Slovenian health care consumer has to report to a service-terminal every three months to renew the electronic card's validity for the following quarter. Once the quarterly term expired, the patient still has the right to receive care as long as the system is able to recognise the patient. Eventually, the public health service expects a 5 percent fall-out of people who probably will omit to quarterly renew their card, such as disabled or elderly patients and therefore is seeking ways to solve this problem.

Only the service-terminals for quarterly updating have an on-line connection with a central back-office coupled to the three national insurance databases. Slovenia has a nationalised health care system and two national companies for supplementary insurance offerings. These three parties are making use of the Slovenian version of the unique patient identification number. Currently, the databases are cleaned up in an extensive process of manual control. The general practitioners, pharmacists and hospitals do not dispose of a network connection up to this point, since a national backbone network with routers and servers would surpass the limited budget.

The Slovenian government has actively promoted the health care card project among the population. The national roll-out took place region per region. In some areas of the country, the electronic card has been introduced two years ago already. Sometimes, implementation was difficult because of card reader problems, network and privacy issues, or the privatised telecommunications provider. In the future, all health care providers and institutions will have to receive a network connection to complement the electronic card with medical functions giving access to medical files.

As early as 1995, a Slovenian delegation visited the Dutch health insurance organisation DSW in order to study their chip card project. The Slovenian electronic card has been set up according to the same technical concept and was recently awarded during Cartes 2000 in Paris as the most original chip card project in European health care. The Slovenian initiative was supported by the national government, the World Bank and several European funding trusts for electronic infrastructure. The Automatisering Gids has served as the news source for this article.


Leslie Versweyveld

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