System of Bonuses in Healthcare Troubles Doctors
The introduction of a bonus system in healthcare is considered rather skeptically by doctors. The healthcare ministry has agreed with emergency units to pay part of the salaries of the teams there in proportion to their workload. Subsequently Minister Moskov surprised GPs with the news that they are preparing a new evaluation system. It stipulates that GPs with the best results will receive bonuses. Medics, however, do not believe that this innovation will actually increase their income.
Agreement between the health department and the heads of the 28 emergency centres provides that the basic salaries of all doctors, nurses and paramedics will be completely levelled. The aim is to eliminate disparities in wages across regions. "There are subsidiaries in which doctor’s assistants get more money than a doctor in a neighbouring city. This situation has been created because the money were given "per person" in the previous wage increase," said Deputy Health Minister Dr. Vanyo Sharkov. The Ministry found that in Varna, where teams are among the most intensively working, the average pay was 750 levs, while in Vidin the income in ambulance services is about 1200 levs. In the future, all emergency medics will receive equal pays, but busiest centers in Sofia, Plovdiv, Varna, Burgas, Veliko Tarnovo and Pleven, which presumably cover most calls will receive a 20% bonus to the salary.
Healthcare workers and ambulances, however, did not understand whether this "alignment" means 20% increase in all salaries, as they had been promised, or the direction will be "down". The Ruse emergency unit logically asked how one defines this factor ‘workload’ - whether the time used to execute the services per address, according to the severity of the case, or because of the remoteness of the teams. "Which team is busier – the one that dealt in two hours with one serious accident or the one who during this time managed to visit 4 or 5 "moderately urgent cases," the asked. And what should be the bonus to the only ambulance in Sozopol, which serves 10 villages in the region?
"For the moment there are no clear criteria by which we will receive bonuses. This system for promoting the intensively working medics cannot be effective. It would apply if all in healthcare were fine," said the chairman of the Association of General Practitioners Assoc. Prof Lyubomir Kirov. According to the leader of the GPs, one of the problems is the lack of money. Therefore, the doctors insist the current budget of the Health Insurance Fund for 2015, and in part the one for GPs, be increased by 20 million levs. Kirov believes that the introduction of a system of bonuses would rather be stressful for the specialists, since it is according to the principle of "divide and rule". GPs want objective quality criteria to be agreed with them and indicate that whole regions in the country - Razgrad, Smolyan, Kardzhali and some part of Northwestern Bulgaria have been stripped from doctors’ services. Dr. Selime Karagyozova added that against enrolled 2,000 patients a GP in Razgrad obtained 500 levs in salary as the half of the patients are uninsured and medics themselves cover travel costs for visiting the villages in the region.