Банкеръ Weekly



Assoc. Prof. Dr. Plamen Kenarov, MP from NMSII, member of the Parliamentary Healthcare Committee, and former director the Tsaritsa Ioanna University Hospital, to the BANKER weeklyMr. Kenarov, during its pre-election campaign the NMSII was promising to the people more and affordable healthcare services. A year and a half later we're witnessing quite the reverse ...- The NMSII promised not only that, but also to increase the money for healthcare. It was projected to reach 6% of the GDP by the year 2005. The budget estimates for the 2003-2005 period show that instead of the promised increase, a gradual reduction of that percentage has been projected, and it will drop to 3.3% of the GDP by 2005. This is in sharp contrast with the promises, given to the electorate. The reluctance to set aside adequate money for healthcare shows that this sector is not a national priority for NMSII's policy. This is something that could shake the stability of national security, because it relies on healthy and not on ill people. The EU member countries set aside between 6 - 12 per cent of their GDP for the sphere of healthcare. We are still not sure we'll have 4.2% of Bulgaria's GDP, because the Finance Minister Milen Velchev is not at all inclined to release that money. He began talking about an increase in BGN millions for healthcare in 2003 as compared to the amount in this year's budget, but he forgot to mention the exact percentage of the GDP. And that percentage is the only real indicator. Anything else is an attempt to conceal the truth from the Bulgarian people. And if the healthcare money for 2003 is not considered a national priority, we'll have as a result a greater depopulation of the country in the next 10-15 years, and the country's national security would be endangered. The fact that the annual number of people who die exceeds by 60,000 the new-born babies in Bulgaria, also bespeaks of that tendency.Your position is hardly liked by your colleagues from the NMSII. Don't you feel uneasy about that?- No, I don't. I can support my standpoint by concrete examples about the practice in developed European countries. I would compare what they do in order to implement the unified healthcare standards accepted by the EU with what is being done in Bulgaria. Or to be more precise - what is not being done, although Eurointegradtion is our priority in foreign policy. Those who do not want the truth to be revealed would accuse me of dissagreement with the pursued policy.The question in fact is if Bulgaria would be accepted in the EU with inadequate healthcare as it is now?- The insufficient money and the blocking of the health reform may bring back in Bulgaria the so-called old social diseases, such as tuberculosis and infantile paralysis. And not a single EU country would admit foreign workers or vacationers, who could infect its citizens with diseases that it has got rid of decades ago. A problem to any developed European country are chronic ailments as well, of which each third Bulgarian suffers. Due to the continuous shortage of money they increase drastically. The number of people suffering from hypertonia, entitled to pay-free medicines, increased from 500,000 in 2001 to almost 2,000,000 now. It is possible that some GPs prescribe more pay-free pills (as the National Healthcare Insurance Fund claims) than really needed. But the real reason is the worsened quality of life and the inadequate prophylaxis. The budget of both the Ministry of Healthcare and of the NHIF is insufficient for preventing ailments. As a result the nations's health as a whole worsens and the percentage of disabled people increases. It would be much more advantageous for the State to invest money in prophylaxis and afterwards get back its money from the taxes paid by the working people instead of paying for patients' charts. If the patients' charts decrease by only a day in a month, proceeds into the Treasury would increase by BGN25MN. Healthcare insurance installments, which are the lowest in Europe could also be a hindrance to Bulgaria's admission into the EU.Do you mean that they should be increased?- Currently, the healthcare insurance installment is only 6% of the income. Even if it is raised, it won't bring us nearer to the European healthcare standards, because only 700,000 people are paying them. For the time being the size of healthcare insurance installments should not be increased, but mechanisms should be worked out for improving the collectibility. After Bulgaria's accession into the EU, however, it should be hiked to 12% of the income.But the unregulated payments in hospitals are a dramatic problem indeed. Some BGN500-600MN is annually paid under the counter in hospitals. This amount is almost one third of the healthcare budget, which is BGN1.460BN.At the same time the health reform has almost come to a halt...- Unlike most of my colleagues in Parliament I admit that if the tendency of reducing the budget for healthcare continues, the health reform would not only stop, but what we have already reached would collapse. The ruling majority and the Government now hope that the restructuring of hospitals is a way out of this situation. But it is doomed to failure if no additional funds are set aside. Restructuring does not only mean closing down a department and transferring its personnel to another one. When a medical establishment is shut down its patients should be redirected to others, which are to be remodelled in such a way as to satisfy the increased demand for medical aid. Centres for incurable patients are to be established as well. These requirements are new for our healthcare, but they are included in the EU healthcare standards and we cannot fulfill them at present. If hospitals' restructuring begins without the necessary money, the reform in healthcare will suffer a failure. That is why before voting the budget for healthcare, the MPs should be fully aware of what they want - a system that works and is being reformed meanwhile, or a system that vegetates and would gradually collapse.

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