The new team of Bulgaria's Healthcare Ministry has set out an ambitious target to kick-start long-awaited reforms to introduce the second pillar of health insurance.

The plan called for cutting the scope of basic medical services package reimbursed by the National Healthcare Insurance Fund (NHIF), to make room for private players to join in and build on.

To this end, the ministry could tap the NHIF's reserves of some 400 million leva, parked with the central bank, or seek a state subsidy, Healthcare Minister Bozhidar Nanev said, ruling out an increase in healthcare contribution rate before 2010.

However, healthcare contributions would start to climb as soon as the market would shake off the recession until it would reach European levels.

Bulgaria still had the lowest healthcare contribution rate of 8 per cent, compared to 12 per cent in Romania.

Healthcare sector representatives hailed the ministry's firm resolve to overhaul the system as "something good". However, private healthcare funds saw their participation in the mandatory health insurance in 2011 at the earliest, provided that all company re-licensing and customer-building rules would be clearly defined.

"Co-payment covered by supplementary funds was part and parcel of the modern healthcare system," said the chair of the Bulgarian Doctors Union Tsvetan Raichinov.

The Bulgarian healthcare insurance model needed meaningful improvements, Nanev said, citing the system's chronic shortage of funding, the large number of uninsured - in excess of one million - and the large package of medical services the state was unable to cover, leading to out-of-pocket payments by hospital patients.

To illustrate his point, Nanev cited the 55/45 ratio between public and private healthcare costs in Bulgaria, with the bulk of co-payments by patients being unlawful, against 70:30 in Europe.

Nanev called for a major restructuring, involving unpopular measures, including stern fiscal discipline and legislating for a second pillar insurance.

The bills for the heathcare system revamp would be filed with parliament this year, Nanev said, without saying when they would be voted on and come into force.

Source: Dnevnik.bg