There is only one key theme describing market access for medical technologies in Slovenia:
- Reimbursement: payment mechanism via the DRG-adjusted budget system, List of separately billed materials
Hospital care is financed via a budget adjusted for activity based on DRGs.
DRGs are determined by the combination of a procedure code (List of therapeutic and diagnostic procedures, an adjustment of the Australian ACHI classification) and a diagnosis code (ICD-10-AM). The procedure coding list and the DRG system are maintained by the Slovenian Health Insurance Fund (ZZZS).
The possibilities for establishing new codes and DRGs are limited on the national level, as the system is simply adopted from Australia (approximately every 10 years; translated into Slovenian and maintained by the National Institute of Public Health, NIJZ). DRG cost weights are updated annually and are published in the “General Agreement” by the Slovenian Health Insurance Fund.
Certain materials are paid for separately, outside of the DRG system. These materials are present in the List of separately billed materials, LZM.
Specifics for IVD tests
In-vitro diagnostic tests provided in ambulatory settings are reimbursed on a fee-for-service basis via the List of laboratory tests, as present in the “General Agreement”.
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