REFORM KNOCKS ON HOSPITALS' DOORS
Statements about hospital aid restructuring of Healthcare Minister Prof. Radoslav Gaydarski are becoming more and more frequent recently. This is logical as healthy people also know that the state of healthcare in Bulgaria is progressing towards its critical level. Processes, however, are slow and doctors regard the Healthcare Ministry's plans as a kind of menaces.
Restructuring in hospital aid is associated mostly with lay-offs, reductions, and close-downs by both strategists and clerks, doctors and managers. It doesn't matter if doctors or other personnel is concerned, beds, wards, or clinics. This process has in fact already started. Such actions are being taken even in big university medical establishments. The management of the Alexandrovska Hospital reported that the first stage of its internal restructuring has already been completed. The acute respiratory insufficiency clinic and the intensive care wards have have been transferred to the big surgical clinics of the medical establishment. Transformation of the nephrology and cardiology units is being considered as well. The changes cannot but affect also the hospital's administrative unit which is often cited as a bad example by its numerousness.
Touring around the country to discuss the National Healthcare Strategy Prof. Gaydarski did not miss to see how the land for the future reforms lies. In Veliko Tarnovo he spotted a deserted terrain near a hospital and recommended that part of it should be sold out. For the BANKER weekly he specified that is an area of 90 dca, overgrown with grass and bushes, which could not be looked after. There is also a huge building from some 15-20 years ago which is like a wound in the hospital's yard. A morass has been formed as well. Considering that the land is expensive, why not sell some of it and cover part of the hospital's liabilities and improve its equipment by the received money?, Prof. Gaydarski asks rhetorically.
There were similar statement in Soumen as well. About
30 hospitals will be closed down
by the year-end, Healthcare Minister said point blank. Of course, the issue is always accompanied by the specification that the big hospitals - university and regional - are priori guarded against such faith. Being the backbone of healthcare they should remain to service as a state guarantee of the hospital aid to the population. But medical establishments which are not in compliance with the modern medical standards about equipment, specialists and operation, should be transformed into something else, e.g. diagnostic and consultative centres (polyclinics), specialized hospitals for treatment of certain kinds of illnesses, or in hospices...
The change in the character of activity brings after itself more serious concussions from the restructuring of the healthcare establishment. That is probably the reason why no hospital has been closed down yet. In addition to the changes in the Alexandrovska Hospital, transformation of three hospitals in the region of Razgrad has been already approved - the regional one, and the municipal hospitals in the towns of Kubrat and Isperih. The aggregate worth of the projects is BGN2MN, to be received under a loan agreement with the World Bank. BGN1.06MN has been earmarked for the Multiprofile Hospital in Razgrad. The money will go for renovation of the surgical ward, the number of beds for active medical treatment will be reduced, and 60 beds will be opened for rehabilitation, physiotherapy and final curing. BGN470,000 has been intended for Isperih where a sector with 20 beds will be opened for final curing (at the expense of a smaller number of beds for intensive treatment), and the anaesthesis and intensive care ward will be enlarged and equipped. The same amount of money and similar internal reconstruction are projected for the hospital in Kubrat.
According to the requirements of the World Bank the draft accounting documentation for the tender procedure was to be ready by end-May. In the words of Dr. Assya Geneva, Director of the Regional Healthcare Centre in Razgrad, it was delayed as it turned out that reconstruction in some of the hospitals had to be greater than initially projected. The project drafters will be completely ready by June 20 and the tenders for the project will begin. The deadline for its implementation is March 31, 2007. No money will come to us, Dr. Geneva specified. We'll be getting equipment and firms that will be making the repairs.
Despite the need of restructuring, the rulers treat very cautiously the issue of
the privatisation of medical establishments
The draft bills of Assoc. Prof. Vassil Panitsa (DSB) and Assoc. Prof. Atanas Shterev (NMSII) were rejected by the Healthcare Ministry and now only God knows when the Parliamentary Commission on Healthcare will be discussing the issue.
It's true that the number of hospitals should be reduced. It is not possible for a country with a population of 7.5 million to be serviced by almost 320 hospitals, Assoc. Prof. Panitsa commented, pointing as an example the Netherlands which population is twice as much as Bulgaria's and where there are only 75 hospitals. The worst part is that privatisation is not given a green light. Any postponement of that problem leads to a more severe crisis in hospital aid. With some 7-8% of hospitals being private property the model of our healthcare is still the same as about 20 years ago, the MP from DSB told the BANKER.
Speaking the truth, divestment entered as an important measure in the healthcare strategy, but it has not been projected as a short-term task. On the other hand, Prof. Gaydarski did not miss the opportunity to repeat in front of the BSP Supreme Council (on May 27) as well his idea for financing the healthcare sector by money from the sale of real estate. However, his estimate that about BGN1BN could be expected from such an operation, was met with a considerable dose of doubts by his long-time opponent Dr. Alexander Chirkov, because many of our hospitals are poor, dirty and nasty, and because Bulgaria is neither Monaco, nor Spain or Germany to expect buyers of land to queue...
The Belgian delegation which visited Bulgaria in May reminded Prof. Gaydarski of one more attitude to hospitals's restructuring, i.e. mergers. The Healthcare Minister liked the Begian experience and promised to unite smaller hospitals into larger ones. He gave an example with St. Ekatherina, Alexandrovska, Maternity Hospital and St. Ivan Rilski in Sofia, which originated from a single medical establishment, but immediately afterwards refused to have said it was exactly these hospitals to be united. One way or the other, the idea won't have much admirers among doctors and a proof of that was the recent protest in the two hospitals in Stara Zagora after rumours about their merger spread.
The most recent
hit in the hospitals sector is the concessioning
According to Healthcare Ministry experts, concessions will make possible private investments in the sector and will be a new chance for improving the management of medical establishments. But as its application in the sector is restricted, most participants in hospitals' management and services remain with the conviction that the so-called restructuring is still seeking its effective forms. It appears that voluntary managerial decisions will be relied on and privatisation will be again waiting for its time to come.