Longterm benchmarking will drive outcome-based health success, says Slovenian minister

Slovenia is moving towards an outcome-based model of healthcare, the country’s health minister told Euractiv on the sidelines of this year’s European Health Forum Gastein (EHFG).

The shift, which echoes the forum’s theme — “Rethinking solidarity in health: Healing Europe’s fractured social contract” — underscores how robust data can underpin trust, equity and resilience across Europe’s health systems.

For Health Minister Dr Valentina Prevolnik Rupel, an economist by training and a long-standing advocate of value-driven policy, the challenge lies not in the next breakthrough drug but in measuring what truly matters: overall health outcomes. Yet, in most European countries, outcomes are still not systematically or comparably measured.

“If you ask me if we make decisions based on the outcome, no. Because we never really measured the outcomes. Of course, basic outcomes like mortality and morbidity have been recognised, but we need more refined measures to assess outcomes for each area,” said Rupel.

Selecting the right indicators

Slovenia is creating a baseline for measurement by defining outcome indicators in oncology, ophthalmology, orthopaedics, and cardiology. The results will allow comparisons that could lead to improving care and achieving better patient outcomes. “That’s something that I really wanted to happen in Slovenia, that’s what I’m pretty passionate about,” she said.

Prevolnik Rupel explained that a working group set up for each of these areas at the Ministry selected the indicators that are available internationally. “Our issue is not that we lack indicators to measure outcomes. The point is that there are too many indicators that measure outcomes,” the minister stated, adding the importance of selecting those that will show if the outcomes really improved.

The work was built on the experience of established programmes such as ICHOM and the OECD’s PARIS initiative. “Of course, we had to validate the indicators we selected in the Slovenian language, we had to do cognitive debriefing with the patients, then we had to buy any copyrights, and now we are in the phase of digitalising them,” the minister added.

And digitisation is key. Around 10 years ago, Slovenia ran a project collecting outcome indicators on paper, “but it didn’t work.” “When collecting outcome indicators, it is essential to do so at a specific time. For example, before the surgery, one day after the surgery, and one month after the surgery,” she noted.

However, when doing it on paper, you cannot control the date like you can digitally. “One hospital would collect the patient outcomes one day after the surgery, another when they leave the hospital or one week after the surgery, and then the results would differ,” she explains why the decision to digitalise the process was chosen.

And then, last year, the government passed a law on healthcare quality assurance. “We created an independent agency which will take care of these quality, outcome indicators. We’ll collect them from the hospitals, statistically analyse them, compare them across the hospitals, see if one is better, where the processes differ, and then exchange the good practice.”

“That’s the point,” she explained, “not to punish the worst ones but to improve the whole system.”

Digitised results

Once digitised, outcome indicators could be sent directly to providers “probably by 2026,” according to the minister.

However, she noted that results will take time to build. “You can’t collect indicators in a month or two. You need enough data for statistical power, patients, control variables, etc. You have to make sure that the data you collect is reliable.”

“Probably, it will not be when I’m a minister,” Prevolnik Rupel commented on when the data will start to give results. “It may take two or three years.”

She also referenced the OECD PARIS programme, saying that Slovenia was the first country to complete the collection of primary healthcare indicators. “We are now analysing them by region, community, and patient group to compare outcomes across physicians, just to see what comes out.”

Asked whether anything stood out on a national level, the minister highlighted one positive finding: “Patients show a very high level of trust in primary healthcare,” she said, adding that it was a result she was expecting “because we have a strong system.”

“The issue, again, is human resources; we lack enough general physicians or family doctors, but when patients reach primary healthcare, the experience is good, and the trust is high.”

CMA’s pivotal role

As Slovenia strengthens its focus on outcomes and data, attention is also shifting to resilience, ensuring secure access to essential medicines. Minister Prevolnik Rupel sees significant value in the forthcoming Critical Medicines Act (CMA), especially for smaller countries like Slovenia.

“By passing the CMA, hopefully next year, I think we can assure that we get access to the essential medicines, through which, of course, we will have a higher resilience in the Slovenian market, we will increase the safety for the patients and also the quality of treatment.”

Commenting especially on joint procurement, the minister sees only positive results, not just for Slovenia, but for all small countries in the EU. “We support joint procurement very much,” she remarked.

GPL needs to close

The General Pharmaceutical Legislation revision is also in the right direction, according to the minister. However, she noted that the procedures “should be finished by the end of this year because it’s been going on for a while now.”

“The Pharma Package is needed and supported in Slovenia,” she explains, “but it has to close.” As far as the Life Sciences Strategy is concerned, for Prevolnik Rupel, expanding clinical research and ensuring that smaller countries have a place in it are important steps.

“Slovenia, again, as a small market, is not typically included in these clinical trials and research, due to its small population, but we would like to be,” she said. However, with recent investments from pharmaceutical companies in Slovenia, Prevolnik Rupel sees growing potential for greater participation in clinical research.

“The companies we’ve spoken to are also interested,” she added, saying that the industry recognises that including more countries, even smaller ones, in clinical trials is essential. “For us, it means earlier access for patients to new medicines.”

Geopolitical uncertainty

Broader geopolitical tensions also came into the conversation. With the persistent US push on drug pricing and investment reshoring, questions remain about whether Europe’s pricing and healthcare systems overall can handle the mounting pressure.

“Nobody knows the full impact,” she said, adding that it is an unprecedented and fragile situation. Slovenia also uses an external reference price system and is a reference country for others.

“It’s such a connected and well-established system of price regulation that it’s very complicated now to say, so what will the tariffs do?” the minister remarked. “It’s not only negotiations that lead to price increases. All the mechanisms that lead to the final price will have to change, and it’s a huge change,” she explained.

“There is a need to ensure a balance between, on one hand, our independence and, on the other, maintaining all the pharmaceutical companies and the medicines that people need in the country,” she added.

[BM]