Many people called their personal doctors to enroll for a checkup after the Health Minister Dr. Petar Moskov said that if routine preventive checkups were skipped, there should be a higher health insurance, announced the GPs.
Even now there is a fine of BGN 50 for skipping the annual checkup provided for in the Health Insurance Act. It has not come into practice as no health minister has so far developed a mechanism for its implementation.
“Increasing health contributions is a good step as a disciplinary measure, but all the details have to be taken into consideration,” said Assoc. Prof. Lyubomir Kirov, chairman of the National Association of General Practitioners. He added that everyone had to follow the rules, and the same way doctors were fined for violations, patients should be sanctioned as well. If the raise of health insurance contributions were paid by the insured, not the employer or the state, for example, there would be a real effect. Prof. Kirov explained that the state paid the contributions for pensioners, children, students, the unemployed and if the measures were automatically applied, the sanction would be distributed among all taxpayers.
Over 50% of Bulgarians over 18 do the mandatory annual preventive checkup at their GPs office, according to the Association. In the last Frame Contract the price for the check up had been increased to BGN 10, and the funds set aside for preventive examinations covered just over half of the insured. Separate are the tests that are not provided for independently, but have to be appointed within the common regulatory standard by the GP. If now 2 million people decide to do the examination, for example, this means at least BGN 40 million more, estimated the Association.
Some go on their own initiative, others – due to a particular health problem, and within the visit are done the preventive examinations as well. They include various activities and tests, depending on the age group.
There should be constant awareness campaigns in the media, because things just got forgotten, said Assoc. Prof. Kirov. Despite everything, however, we should not expect that the prophylactics at the GP office could cover the fully insured.
The expectation that preventive examinations could “detect” all diseases is not realistic as well. The point is to get the picture about the risk or the patients with the major diseases: hypertension, diabetes, certain cancers, obesity, etc. They affect more and more young people and it is important to detect them on time – thus preventing complications, improving the quality of life and lengthening the years of working efficiency.
Assoc. Prof. Kirov emphasized that a lot of patients still thought that the GP should look for them for the preventive check-up. This was a delusion left over from previous times. Patients’ health was their personal responsibility, so they had to be the active side. The GP was required only to declare at a noticeable place in his office what kind of preventive examinations and tests are to be done and with what frequency for the insured over the age of 18.
The GPs themselves have remarks on the amount and scope of the planned examinations and tests. Cholesterol and triglycerides tests, for example – a sign of cardiovascular disease and metabolic syndrome – are provided only for men over the age of 40, and then every five years. Women do this test only after the age of 50 and also with a period 5 years in between.
Assoc. Prof. Kirov explained that this did not suffice and did not provide the sought preventive effect. At the initiative of the Association it was accepted in 2009 that all Bulgarians over the age of 18 should undergo such an examination, and a questionnaire for every patient had to be a filled out during the preventive checkups. Assoc. Prof. Kirov added that they had provided the software and that upon filling out the data from the checkup it immediately indicated the percent of patient risk for various diseases.
The goal was for 2-3 years to cover all and to present a complete picture of the health problems of the population, in order to provide the necessary prevention and therapies. This was done for only 1.5 years, and the opportunities for accurate statistics on people with hypertension, metabolic syndrome, diabetes and other socially significant diseases, were missed.