Банкеръ Weekly



Prices of almost all clinical paths, along which the National Healthcare Insurance Fund (NHIF) pays to hospitals, will be most probably cut down by 20% as of August 1. That measure is necessary due to the cost overrun of money, set aside for financing hospital aid. BGN225MN has been spent on medical treatment in healthcare establishments since the beginning of 2005, while the amount for the whole year has been projected at BGN295MN. Even if BGN85MN from NHIF's operative reserve is used, the money will still be not enough. We cannot divide hospitals into good and bad or correct and incorrect. That is why, the new, lower prices, will be valid for all of them. According to me, there is not a single Bulgarian hospital which does not report fictitious activities, NHIF's head Ivan Bukarev claims. Currently, the NHIF pays hospitals along 120 clinical paths, and the average price of a path is about BGN380. That money accounts for some 60-70% of the real expenses. Due to that difference medical establishments accrue debts each year, which are traditionally settled by the Ministry of Healthcare. Now, by cutting down the money, the NHIF will be paying about 40-50% of the real price for treatment. But in that way hospitals will be over head and ears in debt within no time, suppliers will stop deliveries of medicines and medical goods, and patients will have to cover the difference in the price out of their pockets. The measure will have an educative effect and will bring to less violations on the part of hospitals' managements, Mr. Bukarev believes. NHIF's inspectors have visited 104 multiprofile hospitals, 48 specialized and 12 diagnostics centers, and established a number of blunders. According to Mr. Bukarev, an usual practice is to report fictitious activities and getting money for them. Within the first five months of 2005 hospitals returned to the NHIF more than BGN400,000, wrongfully received, and sanctions worth some BGN300,000 have been imposed on them. Violations in 2004 and the beginning of this year have tripled as compared to 2003. Leaders in terms of violations are the medical institutions in Plovdiv, Sofia and Shoumen. And those in Razgrad have been the most correct in their relations with the NHIF. The analysis of the data, however, shows that when differences are found, no fines are imposed in the majority of cases, and the only requirement is to return the wrongfully received money. Therefore, nobody is alarmed. In order to reduce to the minimum the draining of the NHIF, its management has resolved to mobilize all its resources for carrying out constant inspections. Such intentions have been announced long ago and are even implemented to a certain extend, but the effect is close to zero. This is because of the low size of fines. And they cannot be raised, as they are set in the National Framework Agreement, which on its part, is approved with the agreement of the Bulgarian Doctors' Union. When negotiating sanctions we always make compromises to the professional organisation in order to reach a consensus on the other parameters of the agreement, explains Kiril Ananiev, Chairman of NHIF's Management Board. NHIF's draining is not the only problem. The quality of medical aid in Bulgaria is below any criticism. Treatment in most of the medical establishments is primitive, while the NHIF pays for normal quality, Mr. Bukarev pointed out. But the institution itself is to blame for that. When signing agreements with the hospitals, the NHIF does not set as a condition the evaluation it has received during its accreditation. The Bulgarian healthcare system still lacks rules for the good clinical practice, such as the GMP (Good Manufacturing Practice) in the production of medicines. The experts in the Bulgarian Doctors' Union are already working on the requirements for good-quality medical treatment, but they will be ready in the autumn at the earliest. When signing agreements with the NHIF, many hospitals now declare they have the necessary equipment for a certain treatment, but in fact they do not have it. Many of them do not have specialists with the necessary professional qualification. The most striking, according to Mr. Bukarev, are the cases when for the sake of economizing no consultations with an anaestheologist have been made before operations. An indication about the quality of medical treatment in Bulgaria is the fact that about 10% of the patients have to be hospitalized again only a week or two after they have been discharged from the hospital. In addition to the prices of clinical paths, the NHIF intends to reduce also the money, earmarked for the other kinds of medical activities, but without creating conditions for violations in doctors' normal work. About BGN10MN should be saved from the money projected for GPs, specialists, dentists and diagnostics. Administrative costs are planned to be BGN2-2.5MN down from the money, earmarked in the budget. At least BGN1MN of the capital expenses should be economized as well. If all these measures do not lead to a positive result, the NHIF is considering the possibility to use also half of the amount from the overfulfilment of proceeds. According to forecasts it will be between BGN80-100MN. The possibility of demanding NHIF's budget should not be ruled out as well. That, however, could be done only with a decision of the National Assembly. In any case, the new government and the MPs in 40th Parliament will have to think seriously about the further progress of the reform in healthcare. Mr. Ananiev believes it is necessary to prepare a strategy for structural reforms in the healthcare system and a plan for the privatisation of hospitals.

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