• Dr. Stoycho Katsarov from the Center for Protection of Rights in Healthcare: how to (mis)use power ?!

    November 17, 2014

    The situation with the private Cardiology Hospital in Vidin should be recorded in textbooks as an example of how power is misused without punishment

    - Dr. Katzarov how is power (mis)used without punishment in the structure of healthcare? You specify the situation with the private Cardiology Hospital in Vidin as an example in this respect. Why?
    – The situation with the private Cardiology Hospital in Vidin should be recorded in textbooks as an example of how power can be abused without punishment. In early 2013, a private company entered into a lease of several abandoned premises.

    The investment in repairs and equipment exceeds 3 million BGN. By the end of 2013, the hospital was fully equipped and over 30 employees were employed on permanent contracts. In January 2014 the Regional Health Inspection issued a statement that the new hospital fully met the requirements for receiving an authorization to operate. All documents were filed with the Ministry of Health. The Minister of Health, according to the Law on Healthcare Institutions, was required within 30 days to issue an authorization to operate or give a reasoned refusal. Dr. Tanya Andreeva, the Health Minister at that time, in violation of the law did neither one of these things, nor the other. For ten months the MH was silent. For ten months over 30 people – doctors, nurses and other staff – received salaries, but did not work. The new hospital appealed to the Supreme Administrative Court the silent refusal of the Minister of Health. The Supreme Administrative Court repealed the silent refusal as unlawful and issued directions to the Ministry to make a decision to issue an authorization to operate. Then followed another absurdity – the Ministry of Health appealed the decision of the Supreme Administrative Court before five judges.

    - Why are you defining this appeal as a new absurd?
    – It is absurd because the silent refusal – there is no ruling and this fact cannot be changed, even if fifty-member panel were to examine it. Obviously, it is a case of delay. A delay that will cost a lot to the state budget.

    - How much will this delay cost to each one of us as taxpayers?
    – When the five-member panel of the Supreme Administrative Court eventually confirms the decision to supersede, the state will not only pay for the unnecessary legal costs. There is every reason for the state to pay the existing but defunct hospital a compensation for any loss of profits – incurred investment costs, staff salaries and loss of potential revenue. The waste of money does not stop there. The state, in the face of its Health Minister, decided to “invest” 1.8 million BGN to purchase an angiograph for the State Hospital, although the adjacent private hospital had already purchased and installed one. Moreover, the State Hospital does not even have a Cardiology Department. Activities in the field of Cardiology at State of Hospital “St. Petka” are carried out in the Department of Internal Medicine. In this department works a cardiologist and “three more cardiologists, who have a diploma, but no more than that” who are appointed part-time, but they are not really working. In order to perform activities in Invasive Cardiology it is necessary to have a structure with III level of competence in Cardiology, and that means six cardiologists on a basic labor contract, of which two with a Certificate in Invasive Cardiology and the related equipment. Minister Andreeva transferred 600,000 BGN in advance; Minister Nenkov also joined the game, making the next transfer of 600,000 BGN. Thus by the end of the year Vidin will have two angiographs, but none of them will be working – one because it was not issued a permit, and the other – because there is no one to work with it. The state will bear the losses of several million BGN, while the sick, as it has happened so far, have no access to modern diagnosis and treatment.

    - Are not these ministers responsible for the incurred financial losses to the state budget?
    – One thing is certain, the ones who are guilty for this situation, Minister Andreeva and Minister Nenkov, will not suffer losses, as everything will be left for the taxpayers to pay. When they take the oath, Ministers promise to respect the Constitution and the laws of the country and, as good governors, to take care of public interest. Public interest has not been protected. Whose interest defended the Ministers – we do not know, because they have not given any explanation so far. This fact increases the suspicion of power abuse, and perhaps something else.

    - Now the new ministers are to swear such an Oath. Is it possible for the parties to reach a consensus on healthcare when forming a new government?
    – Each one of the elected in the Parliament parties has set among its priorities
    to reform the healthcare system. This is one of the topics regarding which an agreement will be sought when forming the new government. Reaching an agreement on a plan to reform the health system is not only important, but much more complicated then reaching an agreement for example, for the construction of the “South Stream” or the exit from the crisis with the Corporate Commercial Bank – two other topics of talks for the new government.

    - Why do you think that it is much more difficult to reach such an agreement?
    – Healthcare concerns every person – we start our life in hospital, and many finish it there. Almost 10% of the gross domestic product passes under one form or another through the healthcare system, making it one of the most important ones for the economy and the country’s finances. The fact that healthcare is placed as a priority, however, does not imply that the reform will take place, much less that a successful health reform will take place.

    - What is the basis, upon which such a successful healthcare reform can be built?
    – In the pre-election party programs one can read many proposals – some good, others – not so good, third – frankly populist, and mutually exclusive. In the recent years, the debate on healthcare has focused on a few issues – the deficit in NHIF, the emergency aid, the debts of Public Hospitals, the quality of and the access to medical services, including the additional payment for them, the amount of the health insurance coverage, and the prices on medicines. Probably this is the reason that most people think of hospitals and ambulances when talking about healthcare. Healthcare is much more. Besides hospitals and ambulances, healthcare systems include the clean air, water, food, work conditions, health education, prevention, and other factors, which have a direct impact on public health. These areas also need serious changes, even though it seems easier to reach an agreement about them.

    - Which is the difficult topic, according to you?
    – The difficult topic is medical healthcare – seeking and receiving medical care. Before writing their healthcare reform plan, the ruling coalition has to answer one basic question: what is medical healthcare – a market for medical services or social work?

    - Why do you identify this question as most important?
    – The question is fundamental to the direction of the future health care reform because the measures to be taken by the government in one case and the other are opposed. If the ultimate goal is to make the patient the center of the healthcare system, the decision has to be to stimulate the market, because the user benefits most from the free market and the fair competition. The reform should be aimed at the deregulation, privatization, competition, freedom of choice, etc. If one wants administration to be at the center of healthcare, one has to treat it as social work. In this case, the reform should be aimed at strengthening the regulation, zoning, budgeting, subsidies, etc. There is a middle road, but it does not lead anywhere or it just leads to the spot we are at now. For information – have a look at the last several governments.