DEBT-laden Bulgarian state-owned hospitals will be limited and controlled in spending by new financial plans to regulate their operations.

On February 9, Health Minister Radoslav Gaidarski  said each hospital would be obliged to draft its own financial plan, and set its spending priorities through it.

Bulgaria’s health care system and most of the country’s hospitals, which are owned and run either by the Ministry of Health or the municipalities, have been in a deep crisis over the past several years. Mismanagement has led almost all of them to accumulate large debts, which the state does not want to cover.

The newly-designed financial plans will have mandatory indicators that will be taken into account when assessing the implementation of the tasks. The indicators include the requirements that overdue obligations should not exceed 25 per cent of total expenditure, up to 35 per cent of revenues should be spent on medicines, and at least 80 per cent of the beds should be used.

Gaidarski will have the right to reduce the remuneration of the hospitals’ boards of directors down to 80 per cent upon failiure to fulfill the financial plans or if two of the three indicators have been violated.

Instruction on setting the average working salary in out-patient and in-patient facilities with state or municipal participation is being drafted.

Gaidarski described the new means of hospital funding through a single source, the National Health Insurance Fund (NHIF), as the fairest possible, given that it excludes the possibility for additional distribution of funds, according to unclear criteria. By the end of 2005, hospitals had mixed financing, with part of it coming from the Health Ministry or the municipalities, and another part released by the NHIF.

Gaidarski further said that the Health Ministry budget for 2006 is 405 million leva. This allocation will be used for funding activities, defined as national priority, such as urgent medical assistance, psychiatric hospitals, children’s welfare establishments, blood transfusion centres and national programmes.

Meanwhile, on February 9, Transparency International presented in Sofia parts of its World Corruption Report, which showed that unregulated payments by patients to medical staff had reached up to $1 100 (more than  900 euro).

About 4.4 per cent of each household’s income is spent on informal payments to medics. In the 1992-1997 period, the financial burden for medical services increased from nine to 21 per cent, according to the  figures quoted.

The report says that the sector is susceptible to corruption due to the high number of participants in the health system and the unpredictability of the health care market.
Corruption in health establishments involves unregulated contacts with suppliers, non-application of quality standards and diversion of budget funds or consumer fees for personal benefit.

The data shows that 39 per cent of doctors and 40 per cent of nurses are inclined to lobby for the use of certain pharmaceutical products.