Банкеръ Weekly


Troubled Hospitals Get Absurd Payments

The cult to the financial stability in healthcare sometimes reaches extremely ugly dimensions, contrary to  the very logic, under which the system works. In some case this affect the patients themselves , sometimes the system tests the nerves of doctors and specialists. However, the most state and institutional experiments are done with the money that goes to hospitals. They had to deal with fixed and projected budgets, limits, delayed payments and services offered which no one wants to cover afterwards. At the last meeting of the Supervisory Board of the National Health Insurance Fund (NHIF) experts decided that by the end of 2015 the infirmaries would take no more and no less than 90% of what they reported last year. Head of the Fund, Dr. Rumiana Todorova, expressly pointed out that beyond this amount even a single cent will not be paid. According to her, the situation is not as critical as the hospital started 2014 with a January budget of 137 million levs, which at the end of the year increased to 168 million levs. In turn, the healthcare minister Dr. Peter Moscov as the principal of the  regional healthcare facilities met their directors to inform them of the restriction. Instructions for them were not to touch the salaries of doctors and nurses. But if necessary, they should think about introducing "waiting lists".

Another thematic "arrow" flew right into the Achilles heel of hospitals. To avoid overspending, the NHIF plans to reduce prices of the clinical paths where they reported more medical activities than expected in the original budget. In fact, this is a new text in Article 4 of the National Framework Agreement, through which the Bulgarian Medical Association and the Health Insurance Fund were awarded the right by mutual agreement to negotiate an adjust prices and volumes in the direction both "up" or "down" in order to implement the planned budget.

Th “solid" monthly fixed volume of activities that will be paid has been proven inefficient. This showed data from reports of the healthcare fund. For example, in January 2013 the hospitals reported for services was spent a sum of 93 million levs, while for the first month of last year the amount was over 158 million levs. In February 2013 and 2014 respectively the activities were 103 million levs and 83 million levs. In March 2013 hospital health services cost 114 million levs against 138 million levs in March 2014. That is, there is no way to predict that if a hospital will accept as many patients as in the previous year, or if it will apply the same interventions at the same price as last year so that it may break even. Much more logical it would be if there is any need of correction, this to be done on a quarterly basis to enable the directors of hospitals to still plan their costs to some extent. Otherwise they will be forced to operate at a loss, to deny services patients who are constitutionally entitled to treatment or – what is not better – to make them wait.

According to Deputy Health Minister Dr. Boyko Penkov every hospital has

rules for the famous "waiting lists"

and they only have to post then at a prominent place on their websites. But no patient has seen them   and a few days ago public discussions were led on what criteria these lists may be formed. Uncertainties are many – will hospitals or doctors take responsibility for how "long" those lists may be, which areas of medical treatment will they cover, when and who will determine whether the patient is an "urgent" case or can wait? So the question is not resolved at all, as Mr. Penkov may think.

Even more immoral would be

to adjust prices "on the fly" without consent

of doctors, patients and hospitals. If the planned number of strokes, for example, exceeds the respective number of envisaged cases, is a cost per patient and a pathway supposed to fall down. And who will pay the difference in the cost of service? Or should hospitals start accepting fewer people?

Any type of administrative limits imposed so far have proved to be detrimental to hospitals. Today half of municipal and district hospitals are close to the edge of bankruptcy. The reasons are many - bad management, competition from private owners, badly calculated pathways and urgency, but not as a last reason one can point out the delayed payments  by the health insurance fund, placing health care facilities in a state of chronic indebtedness to suppliers and creditors.


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