NHIF EXPANDS BUT ITS EFFICIENCY PALES
The quality of medical services in Bulgaria has not changed substantially, although five years have already past since the start of reforms in the sector and the funds for healthcare are constantly growing up. This is the main conclusion, prevailing in the public opinion. More and more people in the country do not see any reason to pay healthcare insurance in order to be met in half-ruined consulting rooms, be healed in filthy hospitals, and wait for hours in front of their GP's door. On that background it is hard to believe that the National Healthcare Insurance Fund (NHIF) rates second among all state-run institutions according to the size of expenses made within the last three years. However, there is no real improvement in the healthcare system as a result of the 79% increase of NHIF's expenses. On top of all, 8% of each Bulgarian's salary in 2006 will go for healthcare insurance. The bulk of NHIF's expenses in 2005 will be set aside for medical aid in hospitals, which will receive at least BGN295.1MN for their operation. Additionally, according to the Chairman of the NHIF Kiril Ananiev, another BGN85MN will be allocated to them by the fund's operating reserves. Thus, the total amount will reach BGN380MN. But it's another matter how that money will be spent. Due to the lack of an info system and a sufficiently accurate statistical data in the NHIF, no differentiated methodology for payment of treatment in various healthcare establishments has been worked out. It turns out that the Pirogov Institute for First Aid and all other smaller hospitals will get the same amount of money for an operation of appendix acuta for instance. Thus, big medical establishments accrue debts because the NHIF does not cover to the full extent the expenses they have made but just 40% of them. We have the same situation when it comes to the fixed prices for the various clinical paths. If the Bulgarian Doctors' Union and NHIF's management reach an agreement, the number of clinical paths will increase from 81 to 118 and the prices will be indexed by 7.6% in the National Framework Agreement for 2005. But the problem won't be solved by these measures. The only option for optimal spending of money from the budget is the introduction of a unified info system in the sphere of healthcare. Only then the NHIF will have a clear idea about the treated patients, the expenses for their stay in the hospitals, and will be able to make a more correct price formation and a fairer distribution of money. But that will happen in the end of 2006 at the earliest. In fact, the methodology for financing the state and municipal hospitals, the funds for which come from the Ministry of Healthcare, will be changed in 2005. Until now the ministry was paying to each medical establishment a fixed sum for securing healthcare services. Additional money used to be allocated for each intervention and treatment. As of next year the money will depend solely on the number of effected manipulations and patients. We already possess data about the real expenses for the treatment of various illnesses and we'll be able in future to pay the exact price of the respective medical services. Thus, the BGN725MN, projected in the 2005 budget, will be fairly distributed, Healthare Minister Slavcho Bogoev specified for the BANKER weekly. The ministry will continue to pay different sums for groups of illnesses, but in 2005 they will be more precisely differentiated and the current 17 groups will become 50-60. In the first three months of next year we expect problems in the submission of information, but afterwards the new system will begin to function normally, Mr. Bogoev forecasts. The effect of that innovation, however, will be felt only after several years. Unlike the minister, the directors of state and municipal hospitals believe that the new way of calculating the money won't be quite accurate. According to them it is necessary to introduce also a scheme for covering the capital expenses and repairs, and the amounts should depend on the real needs and not on the calculations of officials. The second biggest expenditure of the NHIF is for medicines for home treatment. BGN245MN for 2005 has been earmarked for the purpose, or up BGN9MN from this year. Nevertheless, the tension will remain, the Association of Scientific Research Pharmaceutical Producers predicts. Dealers from the pharmaceutical branch believe that the money would be completely sufficient if control in hospitals is stronger. Each month the NHIF brings out cases of frauds when doctors report activities which they have not performed. For the first half of 2004 hospitals and doctors were wrongfully paid BGN500,000, which could had been spent for expensive treatment, pharmacists point out. Malpractices, however, cannot be stopped due to the lack of the above-mentioned info system in the NHIF. Until recently it was in fashion to drain the NHIF by reporting invented cases for treatment of tonsils, bronchopneumonia, or heart attack. Now, controlling authorities observe a new tendency. Hospitals tend to report treatment of oncological illness in the last stage, but in fact the patients have a lighter form of the illness. In the first nine months of 2004 the NHIF paid for palliative treatment of 40,000 patients with cancer along clinical paths. And according to the national cancer register, some 16,000 people die of cancer in Bulgaria each year. The third biggest slice of the NHIF budget will go to GPs. BGN103MN will be divided between some 5,000 GPs in 2005. Thus, each of them will get BGN20,600 for the year, or about BGN1,716.6 per month. Salaries of doctors with specialities will be almost within the same range. But dentists will have to be content with less remuneration. NHIF's 2005 financial plan projects BGN49MN for them and BGN41MN for medical diagnostics laboratories. Naturally enough, there are no more babes-in-the-wood, who believe that mechanical pouring of money would radically change the system of public healthcare. Apart from money, the sector needs good managers as well. But rulers have so far showed they do not master healthcare management.