The Health Care Reform – Not By These People, Not In This Way

Автор: Svetla Kostadinova / 28.02.2007

In February 2007 a public discussion took place in the parliament on the topic of ‘Strategic Directions in Health Care’. In the discussion participated the Minister of Health, the Chairman of the Standing Committee on Health Care, the Vice-Chairman of the Health Care Committee of the Bulgarian parliament, representatives of the professional organizations in health care, the syndicates, the governing body of the National Health Insurance Fund, and others. What became apparent from the speeches given by the participants?

1) Privatization of pre-hospital care is planned.

This should have happened a long time ago, and that is why it is necessary to be realized in practice as soon as possible.

2) Hospitals concessions are planned.

This also is a good idea, but presented with the phrase ‘the effect will be negative…and it will lead to increase in public expenditure’ it is a little confusing. In principle, concessions are a way of generating resources for those who provide a concession, i. e. the government, and they lead to decrease in expenditure. Of course, if the goal is to provide concessions without the use of auctions or competitions, as was the case with the ‘Trakia’ highway, the results would be lamentable – but let us hope that such an approach will not be utilized again.

3) Breaking of the monopoly of the state National Health Insurance Fund (NHIF) is not planned.

Not one of those who spoke at the event, besides the author of this article, expressed support for the establishment of private insurance funds, which would compete with the NHIF. This means that we will have to wait for a while before any competition appears, leading to improvement in the quality of service and providing a choice to all citizens who pay their health insurance fees and to all those who rely on using the system. To illustrate this apparent absurdity, imagine that there is a single bank in the country and that the value of the deposited savings into this bank is less than the value of the loans that it granted – what interest rates would this bank offer, what kinds of products would it offer, and would it have any incentive to do anything at all in order to attract or retain customers? And, at the same time, the people in power to be claiming that a bank is a very important and complex ‘thing’ and the private sector would not manage with such an activity, and the state must allocate more funds to cover the difference between the total value of the deposits and that of the loans.

4) ‘The NHIF is not bankrupt’, but still ‘there is the need for more funds from the budget’.

To the claim that the National Health Insurance Fund is about to bankrupt for years now, the Minister of Health replied that the NHIF is still working, which means that it is certainly not bankrupt yet. The question, however, is how and from where it is obtaining funds. In our opinion, if the revenues from health insurance payments are not enough to cover the expenses of the NHIF, it is de facto bankrupt. The chronic deficit, which is covered by the budget at the end of the year, means that the system is ineffective.

5) There is an idea to unite the professional organizations of medical specialists and workers into a Bulgarian Medical Chamber.

This, of course, should have been expected, because only the ones in Bulgaria that still have not thought of creating a nationally representative professional organization, have not done so yet. And if at the moment there is a Bulgarian Pharmaceutical Union, a Bulgarian Doctors’ Union, a Union of Bulgarian Dentists, a Bulgarian Association of Health Care Professionals, and each of those has come up with such rules for regulating their respective professions, that it is almost getting too difficult for non-member practitioners to breathe, then probably a common Chamber will make medical professions the most regulated in Bulgaria. And the chance to reach agreement within such a Chamber on any issue will be a major challenge.

6) The introduction of a system for cutting down expenditures in the area of health care is planned.

Unreservedly, this is perhaps one of the most sensible ideas, which have recently appeared in the public domain pertaining to health care. But, similar to other systems, such as those of the NHIF or the tax authorities, it most likely will not be realized within the next ten years.

In summary, we should state that some of the participants clearly announced their opposition to most of the sensible reforms that were proposed and requested more money. Others explained that the reforms are to proceed but more money will nonetheless be needed. But who is going to provide this money? And should we continue to pour water into a leakey bucket, before patching up the holes on its bottom?