Банкеръ Weekly



Despite the weather forecast for heavy rains in the weekend, temperatures will be quite high in the Katarino complex near Bansko where the political elite of the ruling trio will be sweating over its brand new priority - healthcare. The increase of healthcare insurance instalments, the demonopolization of the National Healthcare Insurance Fund (NHIF), hospitals' divestment and restructuring, and opportunities for increasing the funds in the sector are just some of the hot issues, chewed by the coalition during its entire mandate till now. The problem is that rulers have no useful move amidst the chaos created in the healthcare sector. The lack of concrete reforms will automatically give green light to the projected national protests of doctors and the decisions made without a clear vision for their realization will only make the mess bigger. At the end the tripartite coalition might again leave the mess to be settled by the next government.
It has become clear long ago that
the State does not have the energy to deal away
with the problems in the sector. It cannot even grade them according to their importance, let alone begin the restructuring. It was proven by BSP's plenum on Wednesday (May 7) which only made the mess worse. The big news that the leftists had at last agreed to raise the healthcare instalment was refuted on the very same day by the recently appointed Healthcare Minister Evgeniy Zhelev, according to whom it would remain unchanged for the time being. It became clear as well that the NHIF would be demonopolized but not before 2010. Regarding hospitals, their privatisation will follow but it will be rather something like a public-cum-private partnership. Amendments to a number of legislative acts are being prepared, but the coalition seems to be shooting at random, hoping to hit the target accidentally. BSP is still not willing to launch fundamental reforms, the NMSP is trying to convince it there is no time for postponing them, while the MRF openly hinted that its partners' dawdling might force it boycott all their decisions about the healthcare reform. Therefore, it's almost certain that the trio won't reach consensus this time either.
At the present stage the most severe debates are expected to be those regarding the options for
raising the healthcare insurance instalments
The idea is that the higher rates would ensure additional resources as the Finance Ministry is still not inclined to set aside a higher percentage of the country's gross domestic product (GDP) for the sector (which is currently financed by 4.2% of GDP). Thus, the money will come directly from taxpayers' pockets which naturally is not to BSP's liking. Therefore, the left wing will support an increase of the healthcare insurance instalment from 6% to 8%, but only on condition that the aggregate insurance burden stays unchanged, that is, if the increase is at the expense of lower insurances for pension, general ailment or unemployment. According to Healthcare Minister Zhelev, however, the attitude should be quite different and the additional finds should be sought from the State. One of the options is to raise the instalments from the budget for the children and students under 18 from 3% to 6%, and the other one - to increase the percentage from the GDP set aside for healthcare to 5 per cent. The NMSP and the MRF propose another scenario. They insist that the additional 2% should be managed by private healthcare insurance funds.
Who will manage the health insurance payments
is the other question that the coalition stumbles over. Although the three ruling parties unanimously supported the demonopolisation of the NHIF and agreed that private health funds should operate under the terms of free competition as of 2010, the socialists still fear that a liberalisation of the kind is too risky. The reasons lie in the absence of an approved National Health Strategy and an updated health card. The fund's electronic system is not ready yet and how the voluntary funds will operate and what kind of services they will cover is not clear either. The Minister of Health proposes that they should start operating when they are ready to undertake the full package of medical activities and will not need to send back patients, but the MRF and NMSP insist that this should happen in the beginning of next year.
Relatively fewer discords arise among the coalition partners about the privatisation of the medical institutions, but this doesn't mean it will begin any time soon. The provisions of the Privatisation and Postprivatisation Control Act are still to be amended in order to describe in details the separate units of the hospitals residential fund that are not related to the medical activity and may be ceded. Corrections will probably be made to the list of hospitals not allowed for sale which
may delay the privatisation
by two or three years at least. According to Minister Zhelev, this is the period that will be needed for the restructuring before a decision is made about which hospitals will be offered for sale. He also proposed that the new owners should be totally deprived of the right to change the core business of the hospitals and the currently valid 15-year restriction should be cancelled. His other revolutionary plan stipulates that by July the hospitals managers should sign management agreements binding their remunerations with the hospitals' financial results.
Finally, debates are expected on the more efficient utilisation of the financial resources in the sector, the establishment of an Insurance Fund that would guarantee the stability of the health insurance system, the development of a risk management system through the creation of a Solidary Fund, as well as a number of other hot topics included in the Government's 2008-2009 updated programme. It is clear that two days will not be enough for the rulers to find the answers to so many questions, considering that three fourths of their mandate appeared insufficient.
Yet, they made an impression
by raising the salaries of state hospitals personnel by 15% from May and awarding the Pirogov employees with a 30% increase. All the medical staff will enjoy another 10% increase from July 1 due to the planned increase of the budget sector remunerations. Therefore, the cabinet may be rewarded for its generosity with a calm summer free of medical protests. However, this may only happen if the coalition does not make the wrong step this weekend.

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