Банкеръ Weekly



By end-September the National Healthcare Insurance Fund (NHIF) will not be changing the prices of clinical paths along which its pays to hospitals for the medical treatment, NHIF's Management Board decided. A month ago the managerial team threatened it intended to cut down by 20% its financial participation in them, justifying its decision by the desire to reduce its excess expenses. In the first half of the year alone medical establishments received BGN275MN from the NHIF, while the amount for the whole year has been projected at BGN295MN. Hospitals spend some BGN46MN a month on average, which is almost double the amount, earmarked in the budget. In order to compensate the deficit, the NHIF decided to unblock BGN20MN from its operational reserve. According to NHIF's head Dr. Ivan Bukarev, in that way the necessary funds till end-September will be insured. At the next session of NHIF's Management Board, scheduled for August 29, a decision will be made to release the remaining money in the reserve as well, amounting to BGN65MN. But that will happen only after analysing the volume of effected and paid medical activities. A thorough review of the operation of healthcare establishments and doctors will be made in the beginning of autumn. NHIF's managerial team hopes that the number of patients will decrease in summer and as a result hospitals' expenditures will drop too. They had similar expectations in 2004, too, but they did not come true. Another tactics is under consideration now. If 6,000 patients have been planned for a clinical path, but their real number is 2,000, then a correction will be made and the money will be redirected to another path, Mr. Bukarev explained. He hurried to specify that medical establishments will in no way be sending back patients. This pouring of funds, however, is not a solution to financial problems, because the money won't be enough anyway. There are no prospects that the number of sick people goes down, hospital managers claim. NHIF's statistics prove that. It shows that 380,000 Bulgarians were hospitalized in the first six months of 2004, while their number increased by 39,000 this year, totalling 419,000. The most frequent diagnoses are bronchopneumonia, pulmonary disease, acute and chronicle cardiovascular insufficiency and apoplexy. In order to ensure the normal functioning of hospitals, NHIF's management intends to use half of the overfulfilment of proceeds from healthcare insurance contributions. NHIF's financiers expect it at about BGN80-90MN. If that financial injection is insufficient for overcoming the chronic deficit, some of NHIF's BGN650MN reserve, deposited in BNB, will have to be unblocked. The other option for the NHIF is to demand from the National Assembly to update its budget, as was the case last year. But a sore spot will remain - the smaller amounts which the NHIF will allocate to clinical paths. When the NHIF announced that intention and set August 1 as the date of enforcement of its new price list, the Bulgarian Doctors' Union declared it would not support such a measure. The union's Chairman Dr. Andrey Kehayov said then that if that measure was applied, hospitals' debts would increase headlong. Representatives of the doctors' profession, however, are not so extreme now. Asked by the BANKER weekly if they will support NHIF's proposal in September, Dr. Kehayov replied it was too early to say. In his words, the decision would depend on how many patients have gone through medical establishments and how optimally they have spent the received money. In order to guarantee the right distribution of money from the NHIF its management and that of the Doctors' Union included a new conclusive provision in the National Framework Agreement. It stipulates that the NHIF will be stopping paying to hospitals whose directors do not set aside 30% of their proceeds from clinical paths for medicines and medical goods. That requirement has been included in the agreement, but no sanction for its non-fulfilment has been projected so far. Our inspections showed that in most hospitals the money earmarked for medicines were not spent in accordance with that appropriation. The money goes for repairs or gardens, Mr. Bukarev said. He explained that doctors often make patients buy the medicines, calculated in the clinical path and paid by the NHIF. As a result, the pharmacies nearby healthcare establishments had a huge turnover of medicines which the hospitals were to supply. In a number of healthcare establishments there is an official scheme for patients to pay for certain medicines, medical goods, or manipulations, Dr. Kehayov admitted. This is the reality and we cannot hide it, he said. In his words, the money paid by patients go into the hospitals or into the pockets of doctors in the form of donations for the specially set foundations with the hospitals. However, Mr. Bukarev said that the projected sanctions to be imposed on medical establishments are too low and they will continue to racket patients even after they are fined. In most cases sick people pay without notifying the regional office of the NHIF. Therefore, we do not even know about all cases of malfeasance, NHIF's Director admitted. In addition to cutting down the financing of clinical paths, the NHIF intends to compensate some of its excess expenditures by reducing the money for capital expenses. Mr. Bukarev told the BANKER that the purchase of software, planned in NHIF's investment programme, will not be realized most probably. He also forecast that part of the projected repairs of the regional NHIF buildings would not be carried out. The purchase of premises for storage of archives may be postponed, too, in order to be realized when appropriate buildings are found. Calculations show that if the intentions for reducing investments are fulfilled, savings will total BGN1MN at the most, which is quite a modest amount on the background of the excess expenditures, Mr. Bukarev added. Despite the sad plight of healthcare in Bulgaria and the excess expenses of hospitals, the NHIF intends to buy glasses for working with PCs and suits for its officers. It's doubtful, however, if they will be able to see more clearly the problems in the healthcare system. And as things are looking pretty hot, the NHIF has already published in the Public Procurement Agency a preliminary invitation for participation in a tender for the delivery of 1,216 air conditioners for its premises.

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