Last week, the cabinet approved and will put to a vote in the National Assembly the proposed by the Minister of Health Petar Moskov changes in the Health Insurance Act related to hospitals, pay for medicines, collection of health insurance and others. The goals of the reform are twofold – to increase revenue in the system and make more efficient spending of the funds collected. Here are some of the proposed changes:
Measures against people without health insurance
The state gives a period of only six months to people without health insurance to pay their installments due for three years back to reenter the system. When this period expires, for the recovery of health insurance rights in practice the due installments will be from the commencement of the compulsory health insurance (i.e. from 2000), and not as per current legal regulations – for only three years.
The Minister of Health Petar Moskov explained that efforts by the NRA and the MF to collect health insurance installments are giving results.
The changes provide that the relevant health institutions after examination of an uninsured are obliged within three days to report to the NRA. Moscow explained that the state should know at any time how many are the uninsured.
The measure is put forward as part of proposals to increase the health insurance revenue and increase the revenue of the budget of the NHIF.
More stringent control over the quality of hospital services
The systematic violation of the requirements for quality of medical care will serve as a ground for termination of the funding from the National Health Insurance Fund (NHIF), proposes also the cabinet. According to the requested changes, the contract with the medical care provided can be terminated also when a systematic patients’ dissatisfaction is established. The NHIF is obliged to carry out a study of patient satisfaction with the health services covered.
Two packages of health services will be covered by the NHIF
The package of medical services covered by the Health insurance fund is divided into primary and secondary. The specific medical activities to be included in the packages will be regulated by the Minister of Health in an Ordinance.
The proposed changes reinstate the contractual basis in defining the methodologies for valuation and payment of medical activities, the volumes and prices of medical services, and arrangements for monitoring of the implementation of the contracts between the NHIF and the health care providers, as well as penalties for non-compliance. These relations will be negotiated in the National Framework Agreement (NFA) between NHIF and Bulgarian Medical and Bulgarian Dental Associations. This will enhance the participation of the professional organizations in determining the quality criteria for carrying out medical activities and in the treatment results monitoring.
The Arbitration Committees will be reinstated and they will review the opinions of the persons (health care providers) checked in case of established violation of the NFA.
The state will pay more for the health insured by it subjects
The proposed changes provide for gradual increase of the insurance income by 5% a year starting from 2016, on which the state will pay the health insurance installments to reach the minimum insurance income for self-employed persons. Currently the state pays only half of it, which creates conditions for underfunding of the system and accumulates deficit and affects the quality of health care.