It is now clear that by the end of the year at the latest the number of hospitals in Bulgaria will be reduced. Healthcare Minister Dr. Tanya Andreeva repeatedly pointed out that 400 hospitals are too large a number of a small country such as Bulgaria. The point is that the government should choose the most painless scheme by which to implement unpopular reforms, that will surely spark opposition from hospital directors, medical staff will threaten with strikes and the media will launch a wave of public discontent campaigns. One option for this to happen is by preparing a National Healthcare Map and the state will say which players stay on the market and which go in reserves. Another option is the criteria to be set very high, so that those hospitals that are suffering from lack of enough qualified personnel, modern equipment or are permanently indebted will fall aside automatically.
Minister Andreeva prepared the general public to start thinking in this direction with the statement that she expected the reintroduction of mandatory accreditation for all hospitals, including university ones. This is justifiable on the grounds that the existing (semi-)accreditation system is completely pointless, and that everything should be verified and checked according to the standards that the medical institutions must cover.
In the summer of 2010 the amendments to the Hospitals Act allowed hospitals, specialist centers, laboratories, dental offices and blood banks to choose whether to get accredited, and such accreditation was mandatory only for those who teach students and graduate students. So the only control over medical institutions is done by monitoring the compliance with the medical standards that inspectors from the relevant institution and the Fund make each year. Based on the results of audits clinics receive the appropriate level of competence. But it is an open secret that many of them escape rigorous scrutinizing and obtain licenses without meeting the standards. On the other hand, even if a hospital „is brave enough“ and voluntary submits to an accreditation procedure, the end result is more than clear. The procedure is done under Ordinance 18/2005, in which there are no clear rules for the final grade. Over 3.31 million levs was the sum swallowed by the healthcare ministry in the period 2009-2011 on accreditation of medical institutions and continuing education of medical staff, but it soon was realized that the euro funds were utilized without much practical use.
In this regard, it should be defined how the state will proceed with clinics that do not want to be accredited? The restriction of the National Health Insurance Fund to work only with the accredited ones, has always fallen under the veto of the Ombudsman Ganev. He stated that this way the rulers violate in this way the right of patients to choose where to be treated. Ganev recommended that accreditation should be made by an independent organization outside the administration of the Ministry of Health, and the six-month deadline for submission of documents should be removed. Incidentally, the Ombudsman looked into the issue after the Health Fund refused to sign a contract with a cardio treatment hospitals of Trade League, which were not accredited. Which raises another question – how Minister Andreeva will legally ensure that the licensed private hospitals will be equal to those owned by the state and municipalities. In this respect, there are a lot of good European practices that can be applied.
The BANKER
