Банкеръ Weekly



After all the summer the officers from the National Healthcare Insurance Fund (NHIF) were worrying they were running out of the money which they had to pay under the National Framework Agreement to the hospitals for their activities, at last they made a decision to cut down by 10% the funds for all clinical paths (about 120). Article 207, item 2 of the National Health Act allows them to do that and that was hinted to them by the Chairman of the parliamentary Healthcare Commission, Assoc. prof. Borislav Kitov. The initially demanded measure was to cut down only the money for the clinical paths for which the set number of hospitalisations was exceeded. It could be applied only after and agreement between the two management boards, of the NHIF and of the Bulgarian Doctors' Union. And it did not become a fact in summer. Meanwhile, hospitals were still accepting patients and exceeding NHIF's projections. Thus, its deficit for payment of due amounts reached BGN100MN. BGN80-90MN of it will be covered by money from the overfulfilment of healthcare insurance contributions. That was promised by Parliament after the Chairman of NHIF's Management Board Kiril Ananiev asked for help Healthcare Minister Prof. Radoslav Gaidarsky, who was initially adamant that the money for hospitals should not be cut down, saying there was no drama at all and it was a matter of small amounts of money, but afterwards was the only one who backed the NHIF. The final decision was made at an extraordinary meeting of the National Assembly for discussing the crisis situation. The MPs decided that the minister would move to Parliament a proposal to entitle the NHIF to use the entire amount gathered from the overfulfilment of proceeds from healthcare insurance.All the time there were two options for covering the remaining deficit of BGN10-20MN. The first one was to draw money from BNB's big reserve, which has already reached BGN700MN. For that, however, the budget is to be updated by Parliament which is not likely to happen. Indeed, when approving NHIF's budget in November 2004 it was projected that a planned deficit of BGN111MN for hospitals would be covered by that reserve, but the political situation was different then. Despite all doubts, NHIF's management insisted on that option, while the Bulgarian Doctors' Union insisted that the expenses should be covered by pouring the money into those clinical paths where the number of planned patients was exceeded. As it was mentioned above, no agreement was reached between the NHIF and the Bulgarian Doctors' Union. All the time during the negotiations, the professional organisation was adamantly vindicating its stance, pointing out that otherwise the patients will be those whose interests would be injured and the hospitals won't be able to cover the costs for paying the purchased equipment (which is from financing of clinical paths). In fact, a different motive could be seen through that moving concern. Obviously, the aim of the Chairman of the Bulgarian Doctors' Union, Dr. Andrey Kehayov, was to strengthen his positions within the guild after his recent reappointment to the post last spring, which did not pass smoothly. Let's not forget that 40% of the remunerations to the staff of medical establishments and incentives to doctors are paid from the money for clinical paths. If the NHIF cuts down these funds, hospitals' managers will be forced to do without that extra in order to be able to cover the activities. Even now, only 10% of that money is paid. The other argument of doctors, however, cannot be doubted, as not all clinical paths have drastically exceeded the planned amount of patients. According to NHIF's official analyses, there has been excess hospitalisation along 29 clinical paths, but fulfilment was less that 50% down than projected along 36, and along 92 it was under 100 per cent. By only 8 clinical paths which have not reached 20% of the planned number of patients, the NHIF economises almost BGN1.3MN, i.e. exactly the amount it wants from MPs, doctors and taxpayers. But when Mr. Kitov asked Kiril Ananiev why not cover part of the deficit with money from such economising, he uttered they have made such calculations, but they could not compensate the excess expenses along the remaining paths. So, why was all the threat about NHIF's bankruptcy and accusations that Parliament had approved a budget which is insufficient? It seems Mr. Ananiev has forgotten that in his capacity of a deputy finance minister last year he was moving in the draft framework, which was clearly a pre-election one and would not be sufficient after mid-2005. The truth is that the NHIF cannot go bankrupt as long as there is obligatory healthcare insurance in Bulgaria. The big question, however, is when it will start operating in such a way as to eliminate its problem of making both ends meet.

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