Банкеръ Weekly

Briefs

MONEY FOR HEALTH CARE LIE IN STORE

Patients may sue the National Health Insurance Fund (NHIF), as it has practically violated its contract with them by not extending sufficient finances for medical services in hospitals, lawyers say. The reform in hospitals began on July 1, 2001. Meanwhile, the NHIF put four barriers to its money: it will not go to all hospitals, not for all ailments, not for all sick people, and will not cover all costs for treatment.
At a pre-election meeting in June NHIF's head Dr. Boyko Penkov announced that BGL828MN has been collected since July 1, 1999, when Bulgarians started paying health care insurance provisions. BGL202MN of that amount has already been spent. Thus, BGL626MN remain as free financial resource, at least according to financial statements.
NHIF's 1999 budget projected a balance of BGL114,223,000 at the year-end. However, NHIF began 2000 with BGL197,652,000 on its accounts and by the end of the same year it had gathered the impressive amount of BGL530,554,000. Incomes for 2001 alone are projected to exceed expenses by BGL149,469,000.
The six months of health reform in 2000 cost BGL97,482,000, the official report on the budget fulfillment shows. Health insurance provisions for 2001 have been projected to total BGL399,244,000. Why will then hospitals receive just BGL26MN?
The NHIF presented two views on this matter. According to Dr. Dimitar Iliev, Deputy Chief reponsible for NHIF's finances, even if a larger amount was allocated to the hopsitals it would be absorbed like water in sand because the managers of these health care institutions are not prepared to handle the money. However, Assoc. Prof. Evgeniya Delcheva, head of NHIF's Financial Analyses and Forecasts Department, has another explanation. The total amount for health care cannot be surpassed, because we have to conform to the parametres agreed with the International Monetary Fund, she said to the BANKER weekly. For the current year this is 4.5% of the gross domestic product (GDP), or BGL1,263MN can be spent on health care in the entire country. The lion's share, however, goes to the Ministry of Health Care and we cannot cut down its programmes, NHIF insiders explained.
In spite of these explanations, one question remains: Why the money within NHIF's allowed limit has not been redistributed to the greater advantage of hospitals?
The financial mess, which is presently coming up to the surface, has its roots and they have been evident since the very beginning of the reform in health care. When NHIF's 2000 budget was discussed and approved, the Ministry of Health Care iteself reacted sharply against the steep change in the ratio between expenses for pre-hospital and hospital health care. In 1999, for example, 26% of the money went to polyclinics, while in 2000 the share jumped up to 41 per cent. The Health Ministry's economic experts warned that setting the relative share of health care expenditures at 4.5% of GDP (the initial proposal was 5.4% of GDP) for the 2000-2002 period would have an adverse effect on the hospitals and would result in contradictions between pre-hospital and hospital activities. Moreover, hospitals would not be provided with adequate funds.
NHIF's free money resource is deposited in the Bulgarian National Bank. Part of them were allocated in fixed-term accounts, with BGL280,663,000 by December 31, 2000 on them. In the same year NHIF received BGL681,000 in interests on current and fixed-term deposits, BGL558,000 in interests on bank guarantees, and BGL36,000 in additional proceeds. In that way, NHIF gained more than BGL1.2MN from keeping in store more than BGL600MN!
The only thing that remains now is to use this money (collected for health care) for health, indeed.

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