HEALTHCARE EXPECTS EXPLICIT RULES
The experts of the Bulgarian Doctors' Union have already prepared the new principles, underlying the rules for good medical practice, to be worked out. They are entirely in compliance with the requirements of the Healthcare Act and the legislative acts of the professional organization of doctors and dentists. The document stipulates that the doctors are obliged to inform the patients if they have personal or financial interests in the healthcare establishment to which they direct them for treatment or diagnostication. Moreover, doctors are obliged to act always to the best interest of the patient and should not seek or accept benefits, undermining the doctor's dignity. These words of the experts in fact obscure the ban for doctors to get bribes. However, it is not clear who will be saying if their dignity has been undermined.The requirement for keeping a secret the patients' state of health and to inform them about the risks of the applied treatment, have been stipulated as well. Healthcare workers should render the most qualitative medical aid possible, regardless of the gender, age, race, religion, or sexual orientation of the patient. In the cases when the specialist estimates that the necessary apparata or medicines are not available at the respective healthcare establishment, he should direct the patient to another one. If the doctor ascertains that a healthcare establishment lacks the necessary things for rendering good-quality medical assistance, he should inform the regional healthcare centre about that. According to the accepted rules for good medical practice, a doctor is obliged to keep exact and full documentation about the health status of the patients, as well as about the applied treatment. That requirement will be probably most frequently violated, experts predict. Presently, a great part of the violations, established by the inspectors of the National Healthcare Insurance Fund (NHIF) are connected with mistakes when filling in the documents for reporting medical services. The prepared document, however, is just a general frame of doctors' obligations in the treatment of patients. The professional organization is yet to set up individual managements for good medical practice for all the 50 medical specialities. According to Dr. Andrey Kehayov, Chairman of the Bulgarian Doctors' Union, at least EUR100,000 will be necessary for that. The branch organization, however, does not have that money and has therefore sought financial assistance from the World Bank, the Ministry of Healthcare, and the NHIF. All of them have expressed agreement in principle to finance the establishment of the individual managements, but their exact participation is yet to be agreed. The rules and requirements of the treatment will be written in a simple language, understandable to all people, so that they could themselves see to the quality of their treatment, Dr. Plamen Demirev, secretary general of the union, told the BANKER weekly. He announced that a special commission will be set up within the branch organization, to exercise control on the observation of rules for good medical practice. The body will include representatives of the patients, of the medical establishments, of the Healthcare Ministry, and of the NHIF. According to Dr. Demirev, the administrative sanctions which are currently imposed on doctors who have exceeded their rights or have not fulfilled their obligations, do not improve the quality of medical treatment. Measures that stimulate doctors instead of punishments would have a positive effect, Dr. Demirev believes. According to him, medical assistance is currently of a good quality and NHIF's claims that the treatment is primitive are completely groundless. In his words, the main problem is that doctors do not get a decent remuneration for their qualification and labour. It will be easier to establish the doctors' violations once we have worked out all norms and requirements, Dr. Kehayov claims. After three doctors were deprived of their rights by the Ethics Commission with the Bulgarian Doctors' Union in 2004, the court restored the rights to two of them because no evidence of abuse were found. In future, however, the commissions' decisions will be better substantiated and would hardly be litigated so easily. A curious fact is that within the last three years the Bulgarian Doctors' Union has not received a single claim from patients about demanded bribes on the part of doctors. The Chairman of the union is adamant that the citizens' problems have been solved by the regional ethics commissions and have not been sent to Sofia. Dr. Kehayov believes that illegal payments will be reduced to the minimum after the doctors' salaries are increased. At present, healthcare employees are paid almost one third of the real value of their labour, he said. The low remuneration does not stimulate medical workers to improve and learn new methods of treatment and diagnosis which is a decisive factor for the quality of the medical assistance. Many of the specialists do not attend symposia or training seminars, because they do not have the necessary financial resources. Nevertheless, there is still interest in the training, Dr. Kehayov said. There is a growing number of doctors who take part in post-graduate qualification programs which are part of the Single Credit System for assessment of the forms of continuing medical qualification. The program was created in April 2004 and stipulates that doctors receive additional qualification certificates if they manage to collect 150 points for up to three years. So far the union has signed agreements with 800 partners - medicine universities, training organizations and health centres where medical workers have a chance to improve their skills. Each initiative brings a certain number of points depending on the knowledge it gives the participants.Doctors will be encouraged to improve their qualification if tax reliefs are introduced, Dr. Demirev said. The money spent by doctors on participation in symposia and conferences must be deducted from the taxable amounts, he proposed. Countries such as England and Germany have already adopted this practice.