The balance sheet of the National Health Insurance Fund (NHIF ) in Bulgaria will soon open a deficit of 250-300 million levs and it does not have a reserve that could cover it. The government is delaying to update its budget plan. Moreover, the ruling circles show no intention to withdraw from the payment of full insurance for children, young people and students. In this stalemate, the Fund headed by Dr. Rumiana Todorova is left to its own. And instead of being the body to fairly distribute money for medicines, hospitals, GPs and specialists, its has rather been transformed into repressive institution with primary mission to detect, prevent and suppress threats to its financial stability coming from hospitals.
NHIF is probably a world record holder in non-stop control activities since for the period January-March 2014 it managed to conduct 829 medical and 628 financial audits. Apart from that, the fund checked hospitals on April 18, just before Easter, when inspectors entered 37 hospitals and 191 wards to crack down on the practice for siphoning money from the funds for missing patients. The result – the infirmaries will have to say goodbye to a total of 1.5 million levs for having conducted 1,570 violations related to healthcare services accounted for, but in fact never performed.
The more interesting thing is that hospitals are already striking back by building a skilled and ready for anything „resistance groups“ through which to escape from the eyes of the inspectors. It turns out that Bulgarian healthcare quietly created a new profession – specialists in anti-supervision. These are doctors employed at higher wages just to make reports to the health insurer, being aware of where the medical establishment may get wrong and why its papers may be returned or rejected by the Fund. Dr. Todorova defined the trend as worrying, but the situation is probably quite reminiscent of the saying: „what goes around comes around.“
In fact, the leadership of the Fund slightly overacts by demonstrating excessive supervision and boasting sudden success of their checks. They claim that they found violations in more than one-third of the hospitals, but the deducted sums of a total of 1.5 million levs are dwarfed by the sums of between 350 million and 400 million levs for activities performed done in the first quarter of 2014.
Paradoxically, the management of the Fund itself, it seems, is not aware how far its control powers can extend. In the list of functions of the NHIF very a loose term is written: „it performs medical and financial control over the compulsory health insurance.“ According to Dr. R. Todorova the healthcare fund can only draw conclusions, while the actual violations about the quality of medical services are sanctioned by the Medical Audit Agency. Meanwhile, Mrs. Todorova herself accused clinics that received health insured women in risk pregnancy without measuring their blood pressure or take their blood samples. Again in her words, the manager the hospital in Dupnitza, southeastern Bulgaria, registered an extraordinary high number of people from cardiac asthma and patients massively entered the infirmary under these high-priced pathways.
Moreover, experts „discovered that in some cases patients have come into hospital emergency rooms, without being emergencies“. Hardly so shocking is the fact that hospitals treat people only for the disease in their clinical pathway, for which they were accepted as patients, without caring for their accompanying diseases. If they do, under the current financial model, no one will pay them for the extra effort. For them it is more profitable to take sick people a month later, under a different clinical pathway. This is a normal operating practice.
The BANKER
