Банкеръ Weekly



There are at least 201 people in Bulgaria who should be satisfied with the health strategy. According to Healthcare Minister Radoslav Gaydarski, there are 200 experts who have worked on the draft document. However, a month after it was published on the website of the ministry, there are neither executors nor consumers who have expressed satisfaction and supported the planned changes in the system.
As a matter of fact, the strategy contains bright ideas about the providing of quality and guaranteed health services, optimization of the initial assistance (the one provided by general practitioners), providing financial stability, efficient application of the European legislation and utilization of the EU funds... These are some of its objectives which indisputably will bring profit. The problem is that they are often regarded as mere wishes.
As it was expected, the Bulgarian Doctors' Union was among the first who objected against the draft unambiguously, particularly against the facts that its preparation did not involve doctors and patients, it did not take into account the needs, priorities, and methods for solution of the concrete problems, and the financial parametres for the period of validity were not specified. Another major weak point is the attempt for eliminating the most democratic achievement of the Bulgarian healthcare - the contractual nature, the branch organisation claims. That's why Radoslav Gaydarski said that the doctors' union wanted to remain the only party negotiating with the healthcare fund, while the ministry insists on involving other interested parties such as patients' organisations, for example. The minister accused the leaders of the Bulgarian Doctors' Union in populism, too, because of its insistence on raising the health installment from 6 to 10 per cent. The strategy stipulates a gradual increase of the payments by 2012. A 10% installment will be a tax burden for the people, Minister Gaydarski said. He expects the state to allocate more funds for the healthcare sector next year.
General practitioners are not delighted by the document, either. Their national union announced that some of its major points need to be revised thoroughly. The doctors propose 14 additional strategic goals with which their activity will become a priority for the health policy.
In the strategy, we did not see intentions for the payment of activities that are specific for the general practitioner - home visits, social activities, etc., the Chairman of the union Dr. Lyubomir Kirov explained to the BANKER. No solution is offered for the 24-hour availability of the first aid. Group practices cannot be imposed imperatively, as it is stipulated. They should represent a doctor's personal choice motivated by the preferences they are supposed to bring. The GPs also opposed the introduction of an upper limit in the patients' lists. The application will not only restrict their income but will also violate the patients' right to choose a doctor to treat them.
A week before the doctors' organisations expressed their position, electronic editions published the opinions of two former health ministers under whose ruling the first two health strategies were prepared. According to Dr. Mimi Vitkova, the additional payment in the hospital assistance planned by the current draft is not formulated clearly. And in the financing field, there are more questions than answers.
In turn, Dr. Ilko Semerdzhiev said that the intentions of the healthcare ministry reflected many of the goals set during the ruling of Ivan Kostov's cabinet. The impression from this strategy is rather disappointing, he said. The text merely hides the unwillingness for taking clear and firm measures for restructuring the hospital sector. There are no health indicators, no management analyses... and, which is the worst, there are no resources to guarantee the achievement of the goals, there is no action plan, no budget and distribution of responsibilities. It means that shilly-shallying goes on as it used to be in the past four years.
The other branch organisation which takes part in the negotiations for the National Frame Agreement, the Union of Stomatologists, noted that the strategy should be accompanied by an action plan and that new policy is needed in the prophylaxis of the main dental diseases, particularly for children. Moreover, the stomatologists reacted harshly to the attempt to let new participants in the negotiations for the frame agreement, such as medical institutions, representatives of employers, etc.
About 40% of the healthcare budget go for medicines but little about that is said in the strategy, Prof. Evgeniy Minkov, Chairman of the Union of Pharmacists, commented. Hints are made that tricks with medicine prices are played in the pharmacies. The truth is that only fixed prices (of prescribed medicines) will solve the problem, he argues. It should be known what the product costs to the producer, what part of the price goes to the pharmacist, and what part - to the distributor. We do not want revolutions but to help for preparing those documents and the solutions for the improvement of work. However, the Ministry of Healthcare does not want any dialogue with us. According to Prof. Minkov, the section of the draft on medicine policy is like the 5-year plans from the communist past, promising a bright future without knowing what resources would be needed.
And patients - in the person of their organisations - felt neglected. But on May 22 Mr. Gaydarski met with their representatives and after discussing some provisions with them declared unanimity on almost all raised issues. Patients' organisations presented four short-term tasks and one permanent, connected with the prophylactics at all levels in medicine services.
For the time being disapproval prevails as a whole in the stances about the healthcare strategy. Meanwhile, it procured its 202nd admirer in the person of Premier Sergey Stanishev who said on TV: The patient should be in the focus of the healthcare strategy. I think that has been achieved.. Afterwards Mr. Gaydarski pointed out that the draft document was open, i.e. amendments could still be made.

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