WHO
© Credits

Slovenia abolishes co-payments to strengthen financial protection, WHO report highlights

14 October 2025
News release
Reading time:

The first comprehensive analysis of affordable access to health care in Slovenia highlights the abolition of co-payments in 2024 as a useful policy instrument for other countries working towards universal health coverage. The report also shows Slovenia performing well in protecting households from out-of-pocket payments compared to many other countries in the European Union (EU) but highlights remaining challenges.

“By abolishing co-payments, Slovenia has set an example of good practice to countries across Europe and beyond,” said Dr Natasha Azzopardi-Muscat, Director of the Division of Health Systems at WHO/Europe. “The reform has simplified the way people access the care they need. It has also reduced transaction costs and complexity in governing the health system.”

Key achievements and challenges

“Can people afford to pay for health care? New evidence on financial protection in Slovenia” finds that around 13 000 households experienced catastrophic health spending in 2022 (1.5% of all households). People who experience catastrophic health spending may not be able to pay for other basic needs such as food, housing and heating. Catastrophic health spending is heavily concentrated in low-income households – affecting over 40% of those in the poorest fifth of the population in 2022 – and mainly driven by spending on dental care, outpatient medicines and outpatient care.

However, the analysis shows that levels of unmet need for health care and dental care in Slovenia are higher than the EU average, driven mainly by waiting times, although cost is also a key driver for dental care. More detailed comparative data are featured on UHC Watch, an online platform tracking progress on affordable access to health care in Europe and Central Asia.

Before the 2024 health financing reform, the low incidence of catastrophic health spending in Slovenia reflected a relatively comprehensive publicly financed benefits package and extensive protection from most co-payments through voluntary health insurance (VHI) covering co-payments. This type of VHI typically covered 95% of people liable for co-payments and was carefully regulated by the government to ensure it was affordable for most people.

In January 2024 the government abolished most co-payments. It replaced the VHI premium covering these co-payments with a new mandatory flat-rate monthly contribution, which is paid by about three quarters of the population, on top of the pre-existing Health Insurance Institute of Slovenia (HIIS) contributions.

Longstanding challenges require policy attention

Alongside these important achievements, the report identifies remaining challenges for affordable access to health care.

  • Slovenia’s very heavy reliance on employment-based contributions (payroll taxes) to finance the health system poses a growing threat in the context of an ageing population. As the working-aged share of the population declines, revenue from payroll taxes is projected to drop, increasing fiscal pressure – a concern echoed in another recent WHO/Europe study, “How does population ageing affect health system financial sustainability and access to health care in Europe?”. In 2022, payroll taxes accounted for nearly 80% of Slovenia’s public revenue for health – higher than in most other EU countries. Without broadening the public revenue base, there is a strong risk that budgetary pressure could push up waiting times, erode coverage and increase catastrophic health spending.
  • Long waiting times increase the take up of VHI offering faster access to treatment, but mainly among people with higher incomes, which is likely to increase unequal access to health care.
  • People are not adequately protected from the “avoidable co-payments” caused by reference pricing for medicines and medical products (a system that requires people to pay out of pocket if there is any difference between the reference price and the pharmacy retail price). These co-payments affected about 13% of prescribed medicines in 2023. There is also a lack of protection from extra charges for some dental treatment.
  • Gaps remain in the benefits package for dental care for adults (which is currently being expanded) and there is limited access to covered vision and hearing aids due to a lack of public awareness.
  • Although some groups of people are exempt from paying the new flat-rate monthly contribution, it remains a regressive financing mechanism, placing a much heavier financial burden on households with lower incomes.
  • Entitlement to the full range of HIIS benefits is now linked not only to payment of regular contributions but also to payment of the new contribution. This could lead to a small but significant gap in population coverage.

Making health care more affordable

Building on recent efforts, the government can consider the following options to continue to improve financial protection, particularly for people with low incomes, and to prevent financial hardship and unmet need from increasing in the future.

  • Broaden the public revenue base for the health system to reduce reliance on employment, so that public revenue for health does not shrink as the population ages.
  • Continue to address long waiting times.
  • Protect people with low incomes from any remaining user charges for covered health care. Avoid introducing or increasing user charges in the future.
  • Improve the affordability of outpatient medicines, as well as dental care for adults, corrective lenses and hearing aids.
  • Address the regressivity of the new flat-rate contribution, so that it no longer imposes a much heavier financial burden on people with lower incomes.
  • Find ways to ensure the HIIS covers the whole population.

About the report

This review is part of a series of country-based studies generating new evidence on affordable access to health care (financial protection) in health systems in Europe. It assesses the extent to which people in Slovenia face financial barriers to access or experience financial hardship when they use health care and covers the period from 2012 to 2025 using data from household budget surveys carried out in 2012, 2015, 2018 and 2022 (the latest available year), data on unmet need for health care up to 2024 (the latest available year) and information on coverage policy (population coverage, service coverage and user charges) up to May 2025.

WHO/Europe monitors affordable access to health care (financial protection) through the WHO Barcelona Office for Health Systems Financing, using regional indicators that are sensitive to equity. Financial protection is central to universal health coverage and a key dimension of health system performance assessment. It is an indicator of the Sustainable Development Goals and part of the European Pillar of Social Rights and is at the heart of the European Programme of Work, WHO/Europe’s strategic framework.

Explore country-level and comparative data and analysis on “UHC Watch”.

The report and UHC Watch benefited from financial assistance from the EU through the EU4Health programme.