Bulgaria will step up measures to boost collection of mandatory health care contributions, restructure hospitals and streamline the National Health Insurance Fund’s (NHIF) management in a string of efforts to put its health system on a firmer footing.

The major overhaul of the country’s health care sector, sponsored by Health Minister Bozhidar Nanev and Finance Minister Simeon Dyankov, was presented at a roundtable discussion on October 6.

One of the goals of the reform is to legislate patient payments for services and products that are currently outside state coverage. The amendments, set to go into effect in 2011, envision that prices would be set by an agency at the Finance Ministry, which would limit lobbying at the stage when prices are being decided.

Doctors’ and dentists’ unions, however, opposed the proposed changes, arguing that they would effectively put an end to the practice of annual national framework agreements that outline prices and maximum amounts reimbursed by NHIF.

According to Dyankov, the framework agreement approach had failed in Bulgaria and the health care system was in dire need of being re-evaluated. Doctors would be consulted after a pricing methodology is drafted, but would no longer play a decisive role, he said.

From 2010, all medical services that are not reimbursed by NHIF will be included in a special list, to be displayed in hospitals so that patients know precisely what they should pay for, and how much. The changes would legalise the unregulated payments that patients make anyway, with the state covering the expenses of low-income earners.

The rest will have the opportunity to buy private health insurance, but private funds would be allowed on the market only in 2011. The specific details of the model were still under discussion, but a bill is expected to be tabled in Parliament by the end of October.

From next year, the Government will pay higher health care contributions for children, senior citizens and students. It will also spend the entire sum gathered from mandatory health care contributions on medical services, no longer setting aside a quarter of that sum for the NHIF reserve.

Organisational reshuffle
Bulgaria has more than 420 hospitals, most of which do not comply with current regulatory requirements. While some could be turned into nursing homes and post-treatment facilities, others will be put into private hands or be allowed to seek private partners for modernisation, according to the Cabinet’s proposal.

"At a time of crisis, we cannot afford the luxury to bounce patients from one hospital to another while the state is covering bulging costs," the head of Parliament’s health committee, Luchezar Ivanov, said.

From 2010, the NHIF will be able to decide with which hospitals it will work, spelling financial trouble for the institutions that fail to secure a contract with the Fund. The backbone of the new streamlined system will be the university hospitals, some of which will be merged to reduce their number. In Sofia alone, of 19 university hospitals, only three will remain, while the nationwide total is envisioned at seven.

One of the amendments envisions that the head of the NHIF would be chosen by Parliament, which, according to Ivanov, would ensure that this would be an apolitical appointment. The fund’s management will also be restructured to introduce an eight-member supervisory board to replace the general meeting.

Dnevnik daily, October 6