Public procurement in healthcare
Between Legislation, Needs, and On-the-Ground Reality. Understanding healthcare financing and decision-making processes helps companies develop realistic business models and identify the right pathways for market entry
Healthcare financing and public procurement
The Slovenian healthcare system is based on a compulsory health insurance model, managed by the Health Insurance Institute of Slovenia (ZZZS). This mandatory insurance provides basic healthcare services for all residents, with funds collected through contributions from employers and employees, as well as from the state budget for specific population groups (e.g. the unemployed, students).
In addition to the compulsory system, Slovenia also has voluntary supplementary health insurance, which has been gradually replaced since 2023 by a new model of mandatory health contribution, in line with the recent intervention legislation.
Funding for healthcare comes from several sources:
- contributions for health insurance,
- state and municipal budgets,
- direct payments by patients,
- European cohesion funds (for infrastructure, equipment, and other investments).
Where do the funds go and who allocates them?
The largest share of healthcare funding in Slovenia comes from compulsory health insurance contributions, collected by both the Health Insurance Institute of Slovenia (ZZZS) and the Financial Administration of the Republic of Slovenia (FURS).
ZZZS acts as the main financier of healthcare services and allocates funds according to agreed programmes, which include:
* contracts with public healthcare institutions and private concession holders,
* reimbursements for cross-border healthcare,
* payments for medicines, medical devices, and healthcare materials,
* compensation for sick leave and other monetary benefits covered by insurance.
In addition, the state budget directly finances several programmes, such as:
* healthcare for socially disadvantaged and uninsured persons,
* investments in healthcare infrastructure,
* public health programmes (vaccination, prevention, health promotion),
* emergency medical services and long-term care,
* systemic reserves to ensure the stability of the healthcare system.
The Ministry of Health sets strategic guidelines and allocates budgetary funds.
The ZZZS manages the largest share of resources and concludes contracts with healthcare providers.
Municipalities are responsible for financing parts of primary healthcare centres and ensuring basic infrastructure.
Finally, European funds are directed primarily towards modernisation, digitalisation, and research projects.
In 2023, the state budget earmarked more than EUR 686 million for healthcare, most of which was dedicated to system development, support activities, hospital investments, and the operation of emergency medical services.
Major recipients of healthcare funds
The main recipients of funds from compulsory health insurance are:
Hospitals (secondary and tertiary level)
Hospitals account for the largest share of ZZZS contractual expenditures, consuming more than half of all service-related funds. These resources primarily cover acute care, surgeries, oncology, emergency medicine, and long-term care.
Primary Healthcare Services
This category includes community health centres, family doctors, paediatricians, gynaecologists, and other primary care providers. Financing is based on the number of registered patients and specific programmes, such as reference clinics for preventive and chronic care management.
Medicines and Medical Devices
We should not forget about pharmaceuticals, which represent one of the fastest-growing expenditure segments in the Slovenian healthcare system. In 2023, spending on medicines increased by 13%, amounting to more than EUR 400 million. A significant share of these costs comes from high-cost hospital medicines and special medical devices, such as insulin pumps and ostomy bags.
Sick Leave Compensation
The Health Insurance Institute of Slovenia (ZZZS) also covers wage compensation during periods of sick leave, which represents a substantial expenditure, especially during epidemics or in cases of long-term illness.
How does public procurement in healthcare work?
Each year, the Health Insurance Institute of Slovenia (ZZZS), in line with national health policies and forecasts, prepares the General Agreement, which defines the scope of healthcare services and the funding model for individual providers (quotas, volumes, and prices). If consensus with stakeholders is not reached, the Government of the Republic of Slovenia adopts a Decree on Compulsory Health Insurance Service Programmes, as was the case in 2023.
Hospitals, primary healthcare centres, and private concession holders then conclude contracts with ZZZS. These contracts specify the volume of services, payment mechanisms, quality indicators, and monitoring procedures. Major investments — such as hospital construction projects or the purchase of MRI scanners — are carried out through public procurement procedures, in accordance with the Public Procurement Act (ZJN-3).
It is no secret that this area is often challenging, with recurring issues such as fragmented tenders, inadequate technical specifications, and non-transparent procedures, as repeatedly noted by the Court of Audit. For this reason, it is essential that the healthcare ecosystem remains as well-informed, transparent, and consistent as possible regarding procurement processes and opportunities for participation.
Public procurement in healthcare: legislation and practice
The field of public procurement in Slovenia is governed by the Public Procurement Act (ZJN-3), which is harmonised with the EU Directive 2014/24/EU. This law sets the framework for transparent, competitive, and non-discriminatory procurement procedures.
The core principles of public procurement include:
- equal treatment of bidders,
- non-discrimination,
- transparency,
- economical and efficient use of public funds.
Several types of procurement procedurest are in use, such as:
- open and restricted procedures,
- negotiated procedure,
- competitive dialogue,
- innovation partnership (particularly relevant for the development of medical innovations).
Public tender portals
The national public tender portal:
Public Procurement Portal
For procurements exceeding EU thresholds, notices are published on the Official Journal of the European Union – Tenders Electronic Daily (TED):
TED – Tenders Electronic Daily
Criteria and eligibility
The most common evaluation criterion is the Most Economically Advantageous Tender (MEAT), which considers not only price but also quality, delivery time, sustainability, and innovation.
All companies that meet the eligibility requirements outlined in the tender documentation may participate—these typically include relevant references, financial capacity, appropriate licences, and certifications (e.g. CE marking for medical devices).
This represents a strategic framework guiding the development of Slovenia’s healthcare system and serves as a practical reference for innovators seeking to align their solutions with the country’s strategic priorities.