Банкеръ Weekly



The National Healthcare Insurance Fund (NHIF) and the Bulgarian Doctors' Union (BDU) came to logger-heads again. The argument is said to be about hospital activities, but in fact money is concerned. In front of the public eyes officers and medicine men started convincing mass media who has the right to what and why do it.
The decision of NHIF's Management Board from June 30 to cut down the prices of 57 (from all 299) clinical paths by 7 to 10% became the apple of discord. The changes entered into effect on the following day, July 1. They concern hospital activities for which the NHIF has reported the highest excess of the volume, projected in the National Framework Agreement (NFA). The official announcement specifies that the cost overrun for the respective paths is also due to wrongful, doubled hospitalisations or non-observance of the algorithms for fair clinical behaviour and medical treatment of patients.
The reaction of the BDU was not delayed. I simply can't make out how NHIF's Management Board dared to make the most incorrect decision, said BDU's Chairman Dr. Andrey Kehayov. Clinical paths are already insufficiently financed. Who will be paying the difference in the reduced prices?
The BDU has always been particularly morbid even to hints of depriving it from its right to negotiate the terms and payment of doctors' work. Last autumn the NHIF tried unilaterally to cut down by 10% the prices of clinical paths but the argument passed through court and the attempt proved unsuccessful. In the beginning of July 2006 the picture looks quite similar, although not the same. The BDU points to articles of the Healthcare Insurance Act and of the NFA which are being violated by the unilateral reduction of clinical paths' prices. The framework agreement regulates also the terms for negotiating and introducing changes through an annex but the NHIF has missed them. However, item 4 of NFA's article 203 stipulates that if no agreement on corrections for exceeded volumes and prices is reached till June 15, a decision for that would be made by NHIF's Management Board by June 30 and it becomes obligatory for all partners of the agreement as of the first day of the following month. That's exactly what happened in practice.
Some days before the decision of June 30 the Chairman of NHIF's Management Board and Deputy Healthcare Minister Dr. Emil Rainov admitted in an interview to the BANKER weekly that there were lapses in the reports about what had been done along clinical paths, allowing NHIF's draining. Nevertheless, he was adamant that the system functions well and it has never been more stable financially. He believed that reduction of clinical paths' prices would hardly be resorted to, but he proved wrong.
After the decision NHIF's acting director Dr. Rumyana Todorova gave an example about the suspiciously high excess of cases along clinical paths. For the first five months of 2005 the NHIF paid for 1,070 cases of pregnancy with realized risk, while 15,178 such patients were reported for the same period of 2006. Healthcare Minister Prof. Radoslav Gaydarski joined the argument indirectly. He principally declared himself against the reduction of prices for hospital activities but did not deny the NHIF's right to undertake actions in order to guarantee financial discipline. However, both the BDU and the Healthcare Minister are asking why all medical establishments should be punished for the faults of several hospitals. Dr. Kehayov specified that the losses to the hospitals would be in the range of 10-15 per cent. He added that the NHIF introduces stricter requirements for the presence of specialists and labs, located near the hospitals. These terms will force some healthcare establishments give up clinical paths which means less proceeds for doctors and worsened access to medical aid for the population. There is another option as well - some hospitals to decide to equip. Considering the financial deficit that could be done only by morally outdated second-hand equipment.
The BDU has already sent letters with argumentation, demanding revocation of NHIF's decision to its managers, to the Healthcare Ministry, to the National Assembly, and to the Parliamentary Healthcare Commission.

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