Банкеръ Weekly



Since the beginning of 2004 the National Healthcare Insurance Fund (NHIF) has been reporting an extreme increase of the cases of toncillitis, gastric infections, cardiovascular insufficiency, bronchopneumonia, etc. According to the fund managers, the rise in the sick rate is not real and is a result of speculations on the part of the hospitals. The NHIF announced that patients are often accepted with a diagnosis that does not respond to their actual state of health. In most cases, doctors report that they are treating patients with a much heavier illness than it is in fact. When this scheme is applied, the fund pays for undone job which leads to over expenditures.Pretending to act for restriction of the misuses, the fund managers sent a special document to the hospitals which contained instructions on the hospitalisation on clinical paths and the post control. The document explains the doctors what symptoms they should look for in order to accept patients in the hospital and when to send a patient to cure himself at home. According to the NHIF director Ivan Bukarev, the strict adherence to the instructions will limit the number of frauds on the part of the hospital management and will stop the constant increase of expenses made for hospital aid.The response of the medics came soon after that. On July 14, the Bulgarian Medical Union declared NHIF's instructions inhumane and limiting the patients' access to hospitals. The union appealed to all of its members to oppose the fund's genocide. The medical union claims that the instructions sent to the hospitals contradict the National Framework Agreement and violate the rights of the health insured people. According to the medics, the NHIF has no over expenditures, but simply runs out of resources. When the 2004 budget was prepared, it was indicated that hospitals will be needing at least BGN400MN while they were launched only BGN305MN, the union explained. The doctors threatened that if the fund manager did not cancel the document, they would take all legal measures to protect the interests of their patients.Then the fund sent additional instructions to the hospitals on how the new regulations should be applied. It turned out that when there is a contradiction between the instructions of NHIF and those of the National Framework Agreement, advantage should be given to the latter. Recommending so, the NHIF manager Ivan Bukarev actually confessed his team had exaggerated. On July 15, Mr. Bukarev even confirmed the thesis of the doctors union that the accumulated debts of the hospitals were not caused by incorrect attitude of the doctors but were provoked by the smaller resources provided by the fund budget.For the first quarter of the year alone, hospitals have spent BGN9MN above the BGN152.5MN allocated for them in the NHIF. Should that speed be kept by the end of the year, over expenditures will reach BGN15MN - BGN18MN. The only way to avoid bankruptcy of the healthcare fund is to deblock some of its reserve funds which now amount to BGN750MN no later than next autumn. However, that money is in the Bulgarian National Bank (BNB) and can only be spent with permission from the National Assembly. If the MPs refuse to bless the move, then there should be a reduction of the money paid by the NHIF for treatment of patients on the separate clinical paths. There may also be a reduction of the salaries of doctors and medical personnel, health experts warn.

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