Банкеръ Weekly


Healthcare Minister Faces Limited Expectations

Asked what is the first thing he will do after entering the Bulgaria's Ministry of Healthcare, Dr. Miroslav Nenkov shot a slightly disturbing answer: "I'll find where the bathroom is." It's actually good that the new minister has a sense of humour as the local healthcare system increasingly resembles a toilet where no one flushes the water. It is hardly likely, however, that Mr. Nenkov will have enough time and power to "sanitize" this room. So the main task now would be "not to do anything stupid," as expressed by the representative of the Confederation of the Supervisory Board of the National Health Insurance Fund (NHIF) Dr. Ivan Kokalov. Given the disastrous situation in the healthcare field, the experts may expect both "everything and nothing" from Nenkov, and will most likely get the latter.

On his turn, the Minister, until recently employed by the Military Medical Academy quite reasonable started with a "small basket", in which he does not expect to collect much fruit. "It is impossible to carry out a healthcare reform for two months. Eventually, in the next two months we will operate with such a budget that should not be spent in its entirety. Because after that there are another three months of the budget year," said Nenkov in his first media appearances. Until recently the head of the department of anesthesiology at the Military Medical Hospital refrained from commenting whether it is necessary to have further update the budget of NHIF. But it is clear that he will have to come up with a position on the issue, after taking note of the situation in the healthcare ministry and whether the windows there "have been washed or replaced."

Mr. Nenkov obviously implies that he will try to work in a "hold on" mode until the election of the new parliament and Government. He is familiar with the strings at the Ministry of Healthcare after he was Deputy Minister of Minister Nikolay Petrov in the previous caretaker cabinet. Curiously, in late May 2014 Mr. Petrov was nominated by the government to head the Military Medical Academy and President Plevneliev signed a decree on his appointment without objections. This suggests that the choice of Nenkov for the healthcare minister now may have been made with the active recommendation of Mr. Petrov.

The professional circles are dominated by skepticism as to what Miroslav Nenkov can change at all. "Dr. Nenkov is hardly likely to be able to make any reforms or bring more money into the healthcare system. Updating of the Fund's budget by 225 million levs will give him some peace and calm, although the amount is not enough," said unionist Kokalov.

Chairman of the health committee in the 42nd National Assembly, Dr. Nigyar Jaffer, however, noted that the Ministry of Healthcare had draft ordinances waiting for months to land for a vote at the Council of Ministers. According to Dr. Jaffer the delayed ordinances should be a priority in the work of the new healthcare minister. She gave as an example the donor programme, waiting for funding from the Norwegian fund, in which Bulgaria could lose millions if it does not make quick decisions. "This is money for registers to strengthen the capacity of different structures for the mentally ill to child healthcare. These are important things for me that for unknown reasons remain on the shelves in someone's offices in the lower levels of the ministry," said Jaffer.

"Dr. Miroslav Nenkov must take care to handle the transfer of the third tranche of the additional money for local hospitals," said President of the Association of Municipal hospitals Dr. Nedelcho Totev. The manager of the hospital in Chirpan adds that the targeted financing of municipal healthcare facilities with 6 million levs by the Ministry was negotiated with Minister Tanya Andreeva for entire six months, and then it waited for as long as that for the first two installments. Director of the Sofia-based St. Anna Hopsital Dr. Dimitar Dimitrov indicated that he knew Dr. Nenkov as a "serious man" from the time they worked at the University Hospital. Dimitrov believes that if the position of interim Minister allows, Nenkov could provide some help to the system, especially if he takes the issue with the reviewing of the limits on activities of the infirmaries imposed by the health fund.

The worst case, which Miroslav Nenkov is to face, was pointed out by the member of the Supervisory Board of NHIF Deyan Denev. Director of the Association of Research-based Pharmaceutical Manufacturers said caretaker Prime Minister must ensure the functioning of the system so that there are no shocks in the supply of medicines. "Given that the revised budget does not provide funds for medicines for home treatment, the Minister should show increased attention in this direction. Once the problem of the health system at the moment is markedly financial, the caretaker government can pave the way for its recovery. This means to create prerequisites the revenue growth in healthcare to catch up with spending growth. Otherwise we face a sure collapse," said Mr. Denev.


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