Bulgaria’s Pre-Election Programmes Lack Ideas for Healthcare Reforms

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In the pre-election programmes of all parties in Bulgaria the topic of healthcare everywhere is claimed as a priority. But if one pays a look at the declared intentions of politicians to reform the most dysfunctional state system, some unpleasant conclusions will come out. Major political forces GERB and socialists from BSP are apparently afraid to dig deep into the wound and change the non-functioning health insurance model. Or they are simply not interested to do so. The smaller parties have open their bags of promises and expect rivers of money to flow to hospitals, patients and doctors. Ideas for healthcare financing and control of spending resources vary in a fairly wide range. In general, however, no political force provides a programme and vision for the future, that can work from tomorrow. Reformist ideas are not lacking, but they are presented in a messy way without specifics in what steps they may be implemented and what is necessary for that purpose of the funding. Some of the proposals are pure utopia and illusion, unless the money allocated as a portion from the gross domestic product for healthcare (4%) are not doubled. The latter, however, is unlikely to happen.

GERB party continues to

hesitate in which direction to steer

changes the healthcare insurance model. The embarrassing disagreement within the party of ex-PM Boyko Borisov on this topic can be seen clearly during its previous term in office when the hasty decision to convert the voluntary health insurance funds into insurers created chaos and uncertainty in the industry. However, GERB returns to the idea of the introduction of diagnosis related groups (DRGs), which have already recorded a failure. In 2012 the nominated healthcare minister Desislava Atanasova said her long-term goal was to initiate legislative changes to ensure the change in the financial model of healthcare pathways to the introduction of DRGs. Then the BANKER weekly wrote that GERB had neither expertise nor the time to carry out the most important reform in the sector. Hospitals still lack the necessary software, they have no coders and economic specialists to make the transformation for several years. Separately, the state budget within 4-5 years should plan additional 2-3 billion levs on healthcare. Borisov’s party anywhere in its election platform promises such a thing, so it is an enigma who and how it will finance these groups. The idea that the health insurance field can be stabilized through administrative and legislative measures to improve the collection of contributions is simply glossing over the matter.

The socialists are even less wordy on the subject. During the period in office of their Cabinet led by Mr. Oresharsky, the Prime Minister himself claimed that the first steps to prepare for the de-monopolization of the health fund have been taken. But they were never made as the party members abandoned the idea. In their election platform now there is not a single word on the subject. Instead, they propose the creation of a fund

to finance healthcare services for socially disadvantaged

citizens. Today, the role of this fund actually is performed by hospitals that treat for free people without health insurance and in such a way accumulate debts.

Understandably, the parties from the right spectrum are more radical. Coalition “The Right” intends to establish a health insurance model similar to the Dutch one. That means free competition between the National Health Insurance Fund and (reconstructed) health funds while patients will be able to choose where their contributions to go. The Reformators’ Bloc, on its turn, will modify the functions of the Health Insurance Fund, which will provide only a basic package of medical services. Their programme stipulates the introduction of a second pension pillar of competing private funds to cover current deficits in the system.

The new ABC party also insists on primary and secondary healthcare packages, and the Fund to pass under the control of the public and patients. Followers of Georgi Parvanov will calculate in a new way the clinical pathways and promise to double the budget for healthcare.

The Movement for Right and Freedoms (DPS) believes that de-monopolization of the health fund is mandatory, and the change of the health insurance model is a must. The party has committed to gradually move towards full payment of health insurance contributions from the state budget for all state employees.



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