The new wave of upheaval in healthcare arose from the huge deficit in the budget of the National Health Insurance Fund (NHIF), grew following the decision of its supervision to pay only 80% of the sums spent by hospitals and became a true tsunami at the extraordinary meeting of the Bulgarian Medical Association. Although the big devastating wave is still far into the ocean of health, it gets inexorably closer and by the end of the year it can sweep all decision-makers in the sector and become a real threat for the next year’s state budget. The problems are at all levels, there is lack of basic consensus among those who could solve it, but in such a sick environment the system is doomed to collapse.
The drama started with problems in the current and the uncertainties about the future budget of the NHIF. It is becoming increasingly evident that in this form the institution cannot operate effectively. The corrupt practice of distributing the resources of the public healthcare fund apiece has become dominant for years, but so far the fund’s management
somehow managed to balance things
and avoid huge troubles. Meanwhile, however, hospitals have increased in numbers, private owners also want their share, and the money is a constant. To this one should add the black hole of oncology that is absorbing more and more money and where the shortage is expected to reach 361 million levs. Pressed back against the wall, the supervisory board of the institution took the unprecedented decision to pay the clinics only 80% of their activities completed by the end of 2013 if the state does not come up with a scheme which can provide at least 150 million levs necessary for covering the expenses of hospital care. What’s worse is that the Minister of Finance Peter Tchobanov also doesn’t have a useful move. First, this is a huge amount for the end of the budget year. But even if somehow it might be found, an additional government funding to a public fund would be a bad signal to those citizens who are conscientiously paying their health insurance contributions.
The alternative is to let the health insurance fund enter 2014 with obligations of the same value, but then the next budget could not be executed without austerity measures. On the other hand, the underpayment of hospital care will certainly
generate high tension and chaos
The professional organization of physicians has already decided that if the money for hospitals are cut by 20%, they will have a perfect right to officially introduce a request for payment of this amount by patients. President of the Medical Association Dr. Tsvetan Raichinov substantiated the request with a text in the current National Framework Agreement under which hospitals are not allowed to ask for an extra charge only for the activities covered at 100 % by the NHIF. Furthermore, members of the organization discussed the idea to stop with the planning and administration to work only with emergencies. The point is that such a decision would violate a bunch of patients’ rights, including the right to treatment and the free choice of hospital, and will undermine the solidarity principle of the health insurance system.
For many people, there is no particular logic to contribute when they are requested to pay extra charges. This idea is applicable to private institutions, most of which already operate on this principle, but will crash in large state hospitals, taking for treatment also uninsured people. It is because of this fact the idea of Raichinov met most serious opposition, namely by the Military Academy Hospital and the Pirogov Emergency Care Centre. The manager of the Military Academy Hospital gen. Stoyan Tonev categorically stated that his hospital will continue to accumulate debt, but will not return patients nor makes them pay. The director of Pirogov, Prof. Stoyan Milanov even said that
there is no way to force the insured
to pay money out of their pockets for surgery or examination and the proposal of the Medical Association is funny and is detrimental not only to patients but also to the doctors. In this regard, the two heads rejected as inadmissible the financial idea doctors to go on a leave as a form of protest.
Even if temporarily suppressed, it seems that the budget crisis of the healthcare fund will spill over to the next year. The manager of the institution, Dr. R. Todorova, already complained that the targets set for 2014 not only fail to solve the problem but will increase the budget gap to 400 million levs. Patients’ representatives and trade unions on the supervisory board are adamant that they will not give in to a budget providing less funding than the payments made in 2013. Patient organizations urge the state to allocate at least 180 million levs for cancer medicines and the money for hospital care to be reduced by 200 million levs.
Another key issue in the near future
that may drive physicians on a strike
for the user fees for checks and hospital stay. The Professional Association voted for the option these fees again to be tied to the minimum wage. Thus, if on 1 January 2014 the lowest wage is 340 levs per month, GPs will take a fee of 3.40 levs to check a patient; while hospitals: 6.80 levs per day per patient. Still, it will be hard to reach a consensus because the government is going in a completely opposite direction. In line with its announced policy to priority support the socially vulnerable, government plans to reduce the fee for pensioners to 1 lev. Health Minister Tanya Andreeva explained that the difference will be borne by the budget of the Ministry.
The BANKER
