Slovenian Court overturns ban on doctors working privately

The Constitutional Court of Slovenia has declared legislative changes that ban doctors in public institutions from also working in private practice unconstitutional, derailing a major part of the government's health reform.

The system in force prior to the ban remains in place until parliament has amended the law, CE Report quotes The Slovenia Times.

Passed this April, the amended Health Services Act completely banned health professionals in public healthcare from working for private providers. They were able to work for other providers in the public health network, but only on a very limited basis.

In a decision, the Constitutional Court held that the ban infringed upon a provision of the Constitution, enshrined in Article 49, that everyone is free to choose their employment.

In doing that, it rejected the Slovenian government's argument that the ban was necessary to secure a sufficient scope of services in the public health system, arguing that measures far less restrictive and invasive than a full ban could be taken instead.

The decision was carried unanimously, and the National Assembly now has a year to remedy the situation.

The case was brought by the Medical Chamber, the Association of Private Doctors and Dentists, and several private health providers. Doctors' two main organisations, the Medical Chamber and the trade union Fides, have been arguing that the ban is harmful, recklessly encroaches on the freedom of medical work and fails to tackle the key issues in public healthcare.

Reactions to top court's decision

All along, doctors have been pointing out that this is a disproportionate and discriminatory measure, Medical Chamber president Bojana Beović told the press after the Constitutional Court's decision was unveiled. The top court has agreed with them that public health institutions have sufficient measures at their disposal to regulate their employees' work for other providers, she added.

Recently, two cases of public healthcare doctors prioritising private practice have been made public. Orthopaedic surgeon Gregor Kavčič, who had referred patients from the Novo Mesto General Hospital to a private provider where he operated and reportedly worked far more for this private clinic than his hospital allowed him to, has been dismissed.

In another case of such anomalies, Mitja Rupreht, a radiologist at the UKC Maribor medical centre, came under scrutiny for performing only 10% of his October MRI scans for the hospital and 90% for two concession holders, including a private clinic.

According to Beović, anomalies should be tackled in a way that does not paralyse the entire system.

Health Minister of Slovenia Valentina Prevolnik Rupel does not see the court's decision as a sign of failure on the part of the government because the court did not deem all of the parts doctors find contentious unconstitutional and did agree with the government that efforts to protect public healthcare are important. They will now consider how to implement the ruling in a satisfactory manner, she added.

Prime Minister Robert Golob agreed, saying the government completely trusted the top court's judgement. The decision will be helpful in efforts to seek a new solution that will be in line with the Constitution, he added.

The coalition mostly regretted the court's decision but vowed to respect it by coming up with a better-argued delineation between public and private healthcare, while the opposition said that Golob had lost his political fight with doctors.

Some parts of reform law pass constitutional review

The doctors' organisations were also challenging a part of the law that bans health professionals from working as sole proprietors within the public network, but the court did not agree with them when it came to that, noting that the right to free enterprise can be restricted in the public interest. Another segment of the law that passed the constitutional review is a part requiring concession holders to employ their own staff.

The court is yet to weigh in on some other parts of the law, so the rule obliging concession holders that are part of the public network to operate in a non-profit manner remains in place for now. It was imposed as part of the reform after several news reports surfaced of providers generating significant profits by performing services paid for with public funds.

President Nataša Pirc Musar said that the Constitutional Court had in fact confirmed the state's legitimate right to separate public healthcare from private practice.

"However, the court clearly said that the principle of proportionality must be taken into account and measures must be chosen that are proportionate," she added, hopeful that the government will swiftly find solutions to remedy unconstitutionality in this case.

Photo: Bor Slana/STA