The context for supply and demand of public online services in Slovenia

Slovenia has a single-level system of local self-government. The municipalities, of which there are 193, are responsible only for local tasks. As a result of the appointment of a new government, responsibility for eGovernment has been transferred from the former Ministry of Information Society to a new Ministry of Public Administration. The new ministry also receives responsibility for overseeing the Government Centre for Informatics, which is in charge of infrastructure development at the operational level, and to support, control and coordinate departmental ICT projects.

Slovenia was the only one of the former Yugoslav republics to be in the first wave of candidates for membership of the European Union. It joined in May 2004. The country's population is two million.

Slovenia has always been the most prosperous region of the former Yugoslavia and has found the transition from a socialist economy to the capitalist free market easier than most. GDP per head is already at 79% of the EU25 level - substantially higher than that of the other transitioning economies of Central Europe. The economy has been growing steadily in recent years. Inequality remains quite low. In mid-2004 Slovenia agreed to adopt the Euro by 2007 and, therefore, must keep its debt levels, budget deficits, interest rates, and inflation levels within the EU's Maastricht criteria.

Key figures about Slovenia[1]

	Slovenia	Ø EU15	Ø EU25
Old age dependency ratio	21.4	25.5	24.5
Population density	98.3	119.8	116.3
GDP per head	79.1	108.6	100
Growth 5 year average	3.28%	1.85%	1.92%
Unemployment rate	6.0%	8.1%	9.0%
Inequality index	22	30	29

Together with Estonia, Slovenia has one of the most advanced positions among the New Member States with regard to development of the Information Society. Rates of Internet access and usage are already ahead of the EU15 average. Broadband is lagging behind, but catching up fast. ICT expenditure is 4.0% per year, which should guarantee that the ICT infrastructure will be brought up to or maintained at a high level in the years to come.

Information Society indicators[2]

	Slovenia	Ø EU15	Ø EU25
Households with Internet access	47%	45%	42%
Broadband penetration	3.8%	7.6%	6.5%
ICT expenditure as percentage of GDP	4.0%	3.2%	2.6%
Digital Divide Index	44.8	53.0	50.1

For take-up of online public services, the ability of citizens to have access to services and information electronically is crucial. In the first quarter of 2004, around 47% of households had access to the Internet, according to the Statistical Office of the Republic of Slovenia. This share is expected to grow in the coming years, thereby widening the potential reach of public online services.

Slovenia's performance on the UN Telecom Index[3]

Sloveniaembarked relatively early on its path to the adoption of ICTs. This is related to the population's high level of interest in innovative technology. Uptake of ICTs has also been driven by the actions of the government such as the computer literacy education programme, the implementation of a network of Public Internet Access Points and the eSchools project. According to data collected by the project Research on Internet (RIS) in 2002, Slovenian Internet users tend to be satisfied with the role of the state in fostering Internet-related development.

Attitude to the Ministry of Information Society has also been positive. It, however, was abolished in November 2004, and its former competences distributed across a number of different Ministries: the Ministry of the Economy, Ministry of Public Administration and Ministry of Higher Education Science and Sport.

eGovernment in Slovenia

Supply of eGovernment services in EU Member States is measured annually as part of the eEurope benchmarking exercise. The data from the latest round of measurement (end 2004) indicates that Slovenia is at the same level of progress than the average of the old Member States (EU15), reaching a score on the online sophistication index of nearly 70%, and on the full online availability index of close to 45%. According to this measure, Slovenia is second only to Estonia among the new Member States. eServices are in place for tax submission and notification, searching for a job, personal documents, car registration, notifying the police, public libraries, documents (birth certificate, marriage certificate), high school and University enrolment and providing health-related administrative information.

Supply of eGovernment services in Slovenia[4]

Other data, collected by the project Research on Internet (RIS), suggests that interest in public online services in the Slovenian population is very high. Slovenia is the country with the highest gap between interest and actual usage of these services. However, wherever public online services are actually available, uptake also tends to be strong. Approximately 23% of regular Internet users communicate online with the government, mostly to download official forms. However, only half of them return the forms using the Internet. Clearly, effort is still required to ensure full use of two-way transaction capabilities.

Moreover, although users tend to be satisfied with the national eGovernment portal in general, they would like to obtain more information and see more new topics and content on the portal.

Government activities for eGovernment and modernisation of the public administration in Slovenia are laid out in a number of core strategic documents, including the Strategy for eCommerce in Public Administration for the Period 2001-2004 (2001), the Strategy for the Republic of Slovenia in the Information Society (2003), the eGovernment Action Plan (2003) and the Strategy for Electronic Commerce in Local Communities (2003).

Core objectives formulated are (a) provision of high quality online services (and related infrastructure) that are oriented to the daily needs of all citizens, including members of ethnic minorities living in the country; (b) full compliance with EU standards and learning from best practice abroad; (c) improving communication between public sector and citizens in order to allow citizens to participate and improve their sense of identification with decisions adopted by the public administration; (d) step-by-step removal of existing barriers to the supply and take-up of eGovernment; (e) continuous monitoring of progress based on European and global comparable indicators; (f) improvements of back-office processes via applications of ICTs in order to increase speed and efficiency also of services provided traditional communication channels.

Until the adoption of the policy strategy on eGovernment, transaction between legal and natural subjects (parties) on the one hand and the state on the other hand was primarily through physical channels. Studies that were carried out in the context of the development of eGovernment policy in Slovenia, which served as a foundation for the Government centre for Informatics, showed that the state could save up to 70% of costs by introducing electronic services. Establishment of the Slovenian Ministry of Information Society in 2001 brought an important impetus for development of eGovernment services.

Uptake of eGovernment among private households[5]

The legal framework for development of eGovernment in the country comprises mainly the Personal Data Protection Act (1999), the Act on Access to Information of Public Interest (2003); the Electronic Commerce and Electronic Signature Act (2000; amendment 2004); the Electronic Communications Act (2003) and the Act on Conditional Access to Protected Electronic Services (2004).

Sloveniahas made good progress in establishing an promoting digital identification. The digital certificate authorities SIGOV-CA and SIGEN-CA, set up for the purpose, issue two types of digital signature: personal and digital web certificates. According to the results of different studies conducted by RIS, Slovenian Internet users are less concerned with online security than users in other EU countries, although they are faced with similar difficulties (viruses, spam, credit card misuse). Trust in the security of the systems is relatively high, which is also reflected in a high number of persons (ca. 125,000) using digital certificates for accessing eGovernment services.

According to the results of RIS research, conducted in 2003, the most often mentioned reason for non-usage of eGovernment services is (perceived) lack of e-content and e-services in Slovenian language that would be attractive to the various types of users. In Slovenia, the Internet is used more often for general purposes (e.g. search for information, education) than in other EU countries, while it is less often used for advanced applications such as fully online transactions.

eHealth in Slovenia

The amount of health-related information on the Slovenian language part of the Internet is extensive. There appears to be, however, a lack of online health information of proven quality and reliability.

Key figures about the Slovenian Health System[6]

	Slovenia	Ø EU15	Ø EU25
Percentage satisfied with own health	79.5%	82.5%	79.8%
Prevalence of long-term illness	26.8%	13.8%	20.0%
Doctors per 100.000 inhabitants	228	233	251
Health expenditure as percentage of GDP	7.8%	7.4%	7.3%

Official supply from state sources of such information is the least developed among all online public services. The majority of online health services are provided by the private-commercial sector. Examples include Med.over.net, the most extensive health related web portal in Slovenian language. The portal is intended for the general public, allowing access to information in a straightforward, simple way. The portal offers facilities that help users find what the are looking for easily, such as a search facility, links to other relevant sites and reference materials. Content provided covers all main health-related areas: healthy living, healthy diet, health hazards, general and specialized information on diseases and medical treatment, and first aid.

Ordinacija.net is eHealth portal which enjoys the support of the Slovenian Ministry of Health. The portal is intended for the general public, allowing access to information in the form of a guide. Apart from offering own content health advice, the website is meant as a help for finding healthcare services provided by organisations across Slovenia. The information is offered in several languages: Slovenian, German, English, Croatian, Italian, Spanish, Serbian and French. The portal provides effective tools that help users locate the information they are interested in. The site stresses that users' security and privacy are being protected.

The Ministry of Health website itself features only limited information targeted at general interest users, such as links to other sites, search tool and the list of frequently asked questions. The Health Insurance Institute website mainly provides content on compulsory health insurance (rights and duties of the insured persons), information about Health Insurance Card and medicines, and about health care providers (the list of health care providers with information about working time and waiting periods), information regarding regional units and branch offices, and advice for EU citizens. The information is offered in Slovenian language except of some basic text in English. The Institute for Public Health of the Republic of Slovenia website is another official website, but does not appear to be much oriented to the needs of users from the general public.

The extent to which family doctors, general practitioners and public health clinics in Slovenia have websites oriented towards the public varies. According to the Health Insurance Institute of Slovenia, in the last 10 years Slovenia has achieved a rather high level of diffusion of computer technology among health care service providers. Utilisation of the Internet is limited, though, partly because Slovenian legislation prohibits commercial self-promotion of health care providers. Website content has to be in conformance with legislation, covering professional quality, correctness and validity of data, and information being easily understandable for the general population and provided in Slovenian language. This means that content of such websites is limited to providing official and easy accessible information of mostly administrative character. In general, most users prefer personal or telephone contact with their doctors.

Online consultancy is offered by some of the health websites in Slovenia. Site users of Med.over.net, the biggest private sector health website, can ask for online advice on health problems and receive answers free of charge. A discussion forum for communication between users is also included. The Slovenian broadcasting company POP TV has launched an Internet website related to health advice (POP's doctors) that enables contacts with doctors from different disciplines via e-mail. Personal advice and consultancy is given free of charge. The service provides anonymity. At present, over 30 doctors provide consultancy and advice. The archives of questions and answers can also be accessed through the website. The inquiry revealed that the biggest advantage of contacts with doctors via e-mail as perceived by the users of these services is a simple way of communication with doctors (39%), anonymity (20%) and access to the advice of doctors from different disciplines (18%). The short time needed to get an answer is also well appreciated by users of the service.

Internet Use for Searching Health Information[7]

A similar service is offered by the Slovene Family Medicine Society's Counselling eForum. Here, a team of doctors answers questions regarding family and general medicine. The service provides anonymity. Archives of forums can also be accessed through the website. However, this website tends to be unknown to the general public. The next limitation is that the website is not suitable for persons with disabilities, especially blind or partly-sighted.

Making appointments and registering online for treatment in public health clinics is not available yet.

Online interaction with a family doctor, specialist or primary health care clinic is a very delicate issue in Slovenia, which needs to be addressed in the future. The Medical Chamber of Slovenia argues that such online interaction is hardly feasible because of the provisions of the Slovenian Personal Data Protection Act. This piece of regulation makes it compulsory to unconditionally protect personal data as much as possible. This applies, of course, in particular to sensitive health-related data. This means that test results, prescription renewal and online appointment scheduling are not available through e-mail or other online means. In general, the same applies to consultation via phone, although in practive doctors may use the telephone for giving information and prescription renewal to well-known patients.

There are some initiatives regarding ePrescription which seek to enable patients who are chronically ill to make prescription renewal through the Internet.

With regard to after hours service, there is as yet no structured telephone-based (triage) system that would allow patients to have access to medical advice after hours, except in emergencies.

Patients who want to receive a Second Opinion in Slovenia need to contact the largest health care centre in Slovenia, the Clinical Centre in Ljubljana, which houses the Slovenian Second Opinion Committee. There is no second opinion online service in Slovenia.

Overall, the availability of eHealth services targeted at end users (patients) is still quite limited in the country. One of the characteristics of Slovenia's health system related to ICT is the poor state of information and documentation systems both for hospitals and patients.

The problem was addressed in the Ministry of Health document Strategic Directives for the 2001-2004 Period, which recognised the setting up an adequate information system as one of the priorities of health sector development. In 2003, the Ministry of Health accepted the White Paper on Health Reform, which put much emphasis on development of an information base in the health system. It also addressed the objective of upgrading the health insurance card, which today is one of the most important projects of the government. While some elements of the "new eHealth card" are already in place (data on allergies, medicines issued and other remedies), the whole process, which will include integration of all relevant personal health-related data, will take up to 10 years.

Other major problems are connected with the high costs of the modern healthcare services and the lack of efficient technological solutions, which would make online communication among patients and doctors quick and easy. Health care institutions in Slovenia tend to be equipped with modern information technology, but much less so are general practitioners. It remains a challenge how to reduce costs while ensuring high quality of services. Access to information, privacy and confidentiality are becoming increasingly important. To improve information access to medical staff and patients while simultaneously ensure data security, privacy and confidentiality.

eHealth policy-making is organised as part of the general strategies and initiatives on development of the Slovenian Information Society. The Action Plan eGovernment up to 2004 foresees the development of eHealth services, which would provide interactive counselling on available services in hospitals and online application for medical treatment. The next step to follow, in two years, will be the introduction of ePrescription. At the moment, the proposed services are still in the phase of development. The only health-related administrative transaction that can be carried out online (or, alternatively, through self-help terminals) is ordering of a convention certificate for emergency medical assistance abroad. Since 1 June 2004, the service of ordering the European Health Insurance Card is offered online. The certificates ordered arrive through regular mail within 3 working days.

Online sales of over-the-counter medicines is legal, but online trade with medications that require prescription is prohibited by law. The sale of non-prescription medicines is limited to verified pharmacies. Pharmaceutical institutions in the Republic of Slovenia are well aware of the importance of the Internet. Gorenjske Lekarne, the second biggest public pharmaceutical institution, has set up an extensive website offering expert information and personal advice on use of drugs.

Satisfaction with National Healthcare System[8]

User orientation in eHealth services

User orientation is gaining ground in the design of eHealth services to be introduced in Slovenia. According to the Action Plan up to 2004, access to administrative services, such as application forms (either for downloading or online completion) and interactive ordering for medical treatment, should be developed in an easy-to-use way.

The introduction of the Slovenian Health Insurance card can be quoted as an example of success through user orientation. The device is widely recognised and accepted among the whole population. The Health Insurance Institute has actively promoted the health card among the population, both on-line and with the usage of traditional media (TV, radio, press). Thus, the promotion of service was crucial for visibility and findability among target population. The Health Insurance Institute is highly relevant organisation, which enjoys a high level of trust among the general population.

Access to the health system in Slovenia is guaranteed for the entire population and health services in general enjoy a high rate of user satisfaction - the highest among all New Member States. Every citizen has the right to choose themselves their personal primary care physician. The list of health care providers in Slovenia is easily accessible through the Internet. The personal physician has got a gate-keeping role for access to secondary and tertiary care. If secondary or tertiary care is needed, the patient is referred to a particular specialist or hospital for consultation or for treatment.

On the negative side, Slovenians are suffering from long waiting lists for treatment in hospitals and by some specialists. Patients are thus interested to have quick and easy access to reliable information online that would make it as easy as possible to take a decision about which hospital or specialist to attend. Comparative information on waiting periods for medical treatment provided by hospitals and specialists is now published on the website of the Health Insurance Institute of Slovenia and on some other websites of Slovenian health care providers.

An RIS survey conducted in 2001 found that more than 60% of the total population are interested in receiving health advice or help for interpretation of diagnosis through online means. Around 58% of Internet users expressed general interest in the usage of eHealth services. Interest is strongest in finding information on usage and properties of medicines. Around 16% of the respondents were interested in buying medicines online.

eHealth services should be designed to answer all questions about where and how citizens can attain medical treatment, and about available healthcare services and providers. Although the supply of such information has much improved in recent years, potential and actual users tend to be unaware of this. They are also concerned about security issues regarding data privacy and confidentiality. Both problems need to be addressed by incresing the visibility and findability of online services, and by promoting data privacy guidelines and their evaluation by independent controllers.

It is clear that more needs to be done with regard to accessibility of online information for persons with disabilities, as well as for members of ethnic minorities who do not speak fluent Slovenian. Access to websites for groups of people with special needs should be safeguarded.

An other problem is that health websites are often not updated regularly, which diminishes their value for users.

Patients are interested in online communication with their doctors, not just for dealing with administrative issues but also for consultation and transmission of test results. The latter may require the establishment of interoperable standardised security services by means of an infrastructure for user authentication via digital signature.

eUser - the Project

The eUser study is funded by the European Commission's IST (Information Society Technology) programme. eUser is a major research and support project which has set out to provide solid evidence as to users' real needs regarding eGovernment, eHealth and eLearning offers, as well as providing data about their attitudes and the uptake levels of current public online services. The project supports the IST programme to achieve its key objectives of putting the user and his/her needs at the centre of IST developments. It provides empirical information on key public eServices domains -eGovernment, eHealth, eLearning - identified as priorities by the European Council, and assesses the demand/supply match in these fields.

The eUser Approach

To achieve its objectives, eUser addresses both generic user-related issues and domain-specific topics, and develops a globally accessible repository of evidence-based knowledge, methods and best practice examples. It pursues an extensive programme of active knowledge translation, transfer and dissemination supported by sophisticated online knowledge dissemination tools. The knowledge base will consolidate both existing knowledge and approaches, and novel data generated by the project through representative population surveys (demand side) in old and new Member States, and through comparative analyses of readiness to address user aspects of public eServices in each Member State (supply side).

The project is designed in two phases. Phase I - the preparatory phase - has developed a conceptual framework that systematically identifies and cross-references user issues and service characteristics in relation to online public services. An EU-wide population survey regarding the needs, experiences and requirements of both current and potential users of online public services has been carried out in early 2005. Concerning the supply side, information from national public sector environments has been collected, about the degree to which the European public sector pays sufficient attention to user-orientation of online services. Good practice examples regarding user-appropriate online public service provisions are being identified and described.

All these results build the basis and provide content for the eUser interactive online knowledge base and support service which is being set up as an online observatory on user issues. This constitutes the basis for active support services on user-centred topics which are being made available inside and outside the IST programme.

eUser Country Briefs

This document has been prepared by empirica based on information provided by two National Correspondents (Prof. Vasja Vehovar and Tanja Sterk, University of Ljubljana, Faculty of Social Sciences) as well as secondary data sources such as Eurostat and other Commission Services.

25 eUser eHealth Country Briefs are available in a common format, one for each member of the enlarged European Union. You can access and download these documents in PDF format (for free) from our website.

More information

Check our results and achievements on: www.euser-eu.org. If you wish to be provided with more details, or to receive news and updates, please contact us at: eUser@empirica.com or get in touch with any of the project partners listed below.

empirica Gesellschaft für Kommunikations- und Technologieforschung mbH (Project Co-ordinator) Oxfordstr. 2, 53111 Bonn, Germany, Tel.: +49 228 985 30 0, www.empirica.com

Danish Technological Institute Center for Competence and IT Kongsvang Allé 29, Aarhus, Denmark, Tel.: +45 72201417, www.teknologisk.dk

Foundation for Research and Technology - Hellas Institute of Computer Science P.O. Box 1385, Heraklion, Crete, GR - 71110 Greece, Tel: +30-2810-391741, www.ics.forth.gr

Work Research Centre Ltd. 1 Greenlea Drive, Terenure, Dublin 6W, Ireland, Tel.: +353 1 492 7042, www.wrc-research.ie

University of British Columbia, Vancouver, BC, Canada #105 - 2194 Health Sciences Mall, Vancouver, B.C., Canada, Tel.: +1 6 04 6 39 46 68 www.cme.med.ubc.ca

National Research Council Canada, Saint John, New Brunswick 127 Carleton Street, Saint John, New Brunswick, Canada, E2L 2Z6, Tel: +1 5 06 6 35 06 33, www.iit-iti.nrc-cnrc.gc.ca

Notes About the Data Sources Used in This Document