The draft of the new National Healthcare Strategy (2014-2020) has somehow allowed a very inconvenient finding for those in power to sneak. In telegraphic style it is noted that informal payments in healthcare amounted to 3.6 percent of the total public expenditure. In other words, with a budget of 3.353 billion levs for 2013, which will be provided by the state and the National Health Insurance Fund, 120 million levs will be paid under the table. Experts from the healthcare ministry found that bribery of the under-reformed for more than 20 years system increases due to a negative functioning of the healthcare system and the poor health status of the population. Nothing more. But at least someone had to mull over the fact where possibly this negative functioning of the system comes from and who, how, and how quickly can this be eliminated.
Recent Eurobarometer survey did find that the most corrupt public sector in the country is precisely healthcare. It turns out that 40 of every 100 bribes enter the cashiers of the hospitals, or rather into the pockets of doctors, GPs and nurses. In Bulgaria registered 1.8 million backroom deals, and it appears that more than 700 thousand of them were in the healthcare sector. Whether it comes to the personal health of a patient who is trying hard to get into the waiting list for an expensive examination, or the financial health of a pharmaceutical company promoting its new products, it is not so important. The essential thing is through their chaotic movements in the sector, the rulers of the past few governments actually legalized bribery as a common means of payment.
Former MP and now head of the Center for the Protection of Rights in Healthcare – Dr. Stoycho Katzarov believes that the problem is systemic and comes from increased government intervention and regulation in the sector. According to him,
the idea of ??medical standards has degenerated
into a tool for the closure of smaller hospitals by placing ridiculous demands on the clinical paths. The same complaints had also the manager of the municipal hospital in Novi Pazar, Dr. Atanas Atanasov. He pointed out that the required number of contracts for specialists who work full time are not consistent with the size and activity of the infirmaries. A paradox occurs that in order to meet the standards and get their hands on the money from the health insurance institute, the majority of hospital managements are forced to artificially increase the number of specialists. Which is a drain on public resources at the highest level.
Corrupt environment and create also the pathways themselves because they are inadequately funded. Clinics make expenditures for activities that in most cases exceed by many times what they are paid by the health insurance system. To compensate for the daylight robbery, and both pay their staff without generating a loss, most of them have introduced additional cash payments. This includes selection of a medical team, VIP rooms, personalized service, special lunches, cable TV and other amenities. They are perfectly legal, but get deep into the pockets of troubled patients. Hospitals that do not have resources to afford it are forced to lie. They inflate the number of examinations really carried out by them, increase the number of hospitalizations or directly ask for money from their patients. The usual trick is that the limits on the clinical pathways are presented as exhausted, and a patient can receive services only he pays. Because of the vicious circle of funding
the incomes of the medical staff are fixed
and do not depend on the quality of work and the budget of the hospital. It is therefore not surprising that if a nurse receives 450 levs per month she may ask for a fiver to move a patient’s bed, or ten bucks to change the bandages. This is the correction between the nominal wage and fair market value of the healthcare service.
A huge mistake and a constant source of corruption was the fact that state allowed doctors working in public hospitals to develop private practices.
The system is suffocated in corruption also in the field of policy on medications. After the auctions for drugs were transferred from the Ministry of Healthcare to hospitals, the prices of some of medications jumped several-fold. Former health minister in the government of GERB Dr. Stefan Konstantinov even said he suspected the largest hospitals in corrupt practices when it became clear that some of them buy large quantities of drugs at higher rates than their smaller competitors. According to Konstantinov up to 2008 the health insurance institute could directly negotiate, push and twist the arms of all pharmaceutical companies in its position of a large buyer, and thus make big savings. It is a well known fact that in recent years pharmaceutical companies have received freely the right to interfere through money not only in hospital management, but also into the work of regular doctors.
Emblematic is the situation with the case against the drug giant Pfizer. Some time ago it paid the U.S. government over USD60 million in order to avoid charges of handing out bribes. During the investigation it became clear that in Bulgaria the company has spent 28 thousand dollars on incentive travels in Greece as a reward for doctors prescribing its products and another 17 thousand on participation in medical conferences for advertising purposes. Although this is in the past, people should look into the case, as the same corrupt doctors decide the fate of many patients even now. This is the reason why the supervisory bodies (with quite a big staff ) have been set up with the Medical Audit Executive Agency
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