2014 is yet another year lost for the Health reform

The intentions for changes in health care are serious, stated Minister Petar Moskov

The shadow of the health reform began to appear on the threshold of the new 2015. Obviously discussions on serious reforms have a slow start and this was evident in the last days of the calendar year when the Minister of Health Petar Moskov presented his vision for reforming the sector. A series of legislative measures are expected before April 2015.

What happened in the health sector in 2014?

The year was marked by two updates of the National Health Insurance Fund (NHIF) budget, scandal emergency crisis with baby vaccines and as a whole – year zero for reforms.

The big dispute about the money of the NHIF this year went through two updates. First in the middle of the year, and second – in the end of it. In August, the Fund’s budget was increased by BGN 225 million, and in November – with another BGN 100 million. So this year’s budget of the health care was mended after many comments for and against providing extra money.

The impotence of the authorities to rein the finances of the health care was demonstrated by the raging summer scandal in emergency aid. In the midst of the scandal with the Metropolitan Emergency different positions and suggestions were heard on what should be done so that the system can function normally. The problems of emergency physicians in the capital were demonstrated by protests that exceeded the limits of Sofia and proved the national scale of the problem. It comes to wages of workers in emergency centers, working conditions, lack of people wishing to pursue this profession, insufficient number of teams, ineffective spending, and bad management. Problems which are not new, but remained for the next year.

Another case – the lack of certain vaccines for babies drove doctors and patients up the wall in the autumn. In late September, doctors warned that the 5-valent vaccine, with which all babies born after 1 June this year should be immunized, is missing. Solving this crisis marked the brief quarterly management of the provisional Minister of Health Miroslav Nenkov who resorted to placing public procurement of 6-valent vaccine through negotiation without announcement. After the crisis found a favorable outcome, the Ministry of Health prepared a framework agreement for the supply of vaccines for the next three years. The Agreement provides the producer, who won the contract to provide vaccines for the next three years, not for one year only.

The parallel export of medicines was restricted. Parallel exports of medicinal products subject to medical prescription will be made after notification to the Bulgarian Drug Agency (BDA) and the Director of the Agency will be able to refuse with a reasoned order as long as it is established that the product is in limited amounts in Bulgaria.

The “Moskov’s” reform

By April 2015 the proposals for legislative changes in the health insurance model should be drawn up, and it is expected three health packages for medical care to be introduced – basic, upgraded and emergency. This is set in “Moskov’s reform. According to the experts, the idea actually is a proposal for a complete change of the health insurance model, which is expected to provoke serious discussions. Such as the discussions on the restructuring of health insurance – it should be specified what part of the installment will cover the basic package and what – the upgraded package.

A clear definition of the basic package of services covered by the Health Insurance Fund is expected, i.e. the treatment of the most common diseases that lead to the greatest mortality in the country. According to the intentions of the Health Minister the additional package will cover non emergencies conditions or socially significant diseases, it will give the opportunity for additional payments, for this second pillar insured will be able to choose between installments to the Health Insurance Fund or private funds.

The third, so-called emergency health package actually means developing clear criteria for emergency – something the emergency physicians have long demanded. Clearly regulated criteria for dividing the real emergency patients from those seeking ambulance for everything are expected. Persons without health insurance can use this particular package of services, and the insured persons will have the basic package so that each insured person will be treated for all diseases. The Ministry of Health is expected to define the criteria for emergency and to clarify the question of who pays for the medical service received if the patient does not meet the noted criteria.

The case of people without health insurance, about two million, is about to get a partial solution. Raising the fee for recovery of health care rights, as a way to curb the possibility for easy entry and exit from the health insurance system is proposed. Currently the reentry in the system of one uninsured is about BGN 600. The proposal is the restoration of the health care rights to be BGN 2000.

There will be changes in medicinal policy. The introduction of centralized negotiations of various discounts on medicines by the Health Insurance Fund is prepared. The idea provides that the Fund will not pay for the medicines if the manufacturer does not provide a discount.

Moskov wants the supervision of the NHIF to determine the list of medicines which will be covered by the Fund with public funds.

The introduction of a mechanism for health technology assessment in the application of medicinal products is proposed. When assessment proves the lack of effectiveness in the implementation of a certain drug, the amounts paid by Heath Insurance Funds for it will be refunded to the budget of the Health Insurance Fund.

The changes provide for gradual increase in the contribution from the state for groups provided by it in increments of 5%, and it will start in 2016. The termination of a contract with medical service provider is stipulated, if systematic dissatisfaction of patients is observed, and the termination of a contract in the event that the quality requirements are violated.

Will these measures solve the problem with the draining of the NHIF and will they close the holes in the fund so as to achieve a balance in the system, these are the questions we expect to get an answer to in the new 2015.