The manager of the Health Fund Dr. Glinka Komitov had predicted that “based on the current performance towards the end of April, we could expect a deficit in the Health Insurance Fund budget at the end of 2015.” According to the NHIF representative, the deficit is formed by medicines and hospital care, so therefore the efforts should be directed primarily at reducing precisely these cost elements. The Fund expects the shortages of medicines for home treatment in the country, of medical devices and dietary foods for special medical purposes to be BGN 108-109 million. The shortage for cancer medicines as of the 30th of April was BGN 59 million, and for hospital care – about BGN 125 million or in total sum – BGN 292 million. Since there is a reserve of BGN 93 million, however, the shortage would be about BGN 200 million. Dr. Komitov explained that this year the base has been lower for the three items and hence the implementation of the budget has been higher than last year.
In connection with these forecasts, Minister Moskov announced that there will not be a deficit of BGN 200 million in the NHIF budget at the end of the year. He added, however, that if there were no changes made to the healthcare system and it continued to function like before, the deficit may be even larger than BGN 200 million. The Minister noted that at present the public spending on healthcare was BGN 4 billion, but BGN 1 billion were not spent as intended. From his words it became clear that there was resistance from the sphere in question where that one billion was spent. “This is a noisy billion. You know, it can produce a media wave, it can make noise, it can create stress in humans,” he said.
Dr. Moskov also announced that the good intentions for changes were being used before the elections to arouse fears and concerns among people and for political purposes. When asked whether there were contradictions within the coalition regarding his actions he replied that there was a majority behind the management program of the government. According to him, for there to be a change to the situation in the country, the parliament majority has to support the changes. “The conversation takes place inside the coalition, topics are being discussed, better solutions are being considered, and behaviors towards the parliamentary forces that oppose the government are deliberated upon. In other words, this is a conversation within the coalition, within the partnership, which forms the government support. There is no big drama,” he added.
Among the reforms lying ahead, Dr. Moskov indicated the breaking up of the health insurance package into primary and secondary. He noted that one of the main directions of the change was the emergency assistance reform, where there was a 4-year plan for its restructuring. After that he pointed out the structural reform and change in the method of funding where the idea was not to pay for structures, but for treatment: “Because the way of payment will propel hospitals to merge. Because the way of payment will fund the treatment, the outcome, and the complexity, but not who, where and why created the hospital or something else,” said the Minister. He announced that part of this restructuring was the national health card, which would make apparent that one cannot open a new hospital where there were already enough of them. “If you want to invest in hospital infrastructure, then go where there are no hospitals, because there are whole areas in the country where the access to people like you and me in Sofia, is impossible for these people – whether in Deliorman, whether in the Rhodopes, whether somewhere else. And this is state policy – where to direct investment, where to promote investments,” the minister added. He also noted that part of the reform was to improve the control and cost effectiveness. In his words, this was related to e-health.
Dr. Moskov said that the planned hospital and dispensary mergers were part of the transition from structure financing to paying for the treatment. He once again explained that at that time many hospitals did not offer comprehensive treatment and the patient was forced to go back and forth from one place to another.
The Health Minister pointed out that in order for such circling around not to happen, patients should be offered complex treatment. He added that the NHIF would conclude a contract only with those hospitals which offer such comprehensive services. “Starting next year the NHIF will enter into contracts with hospital or hospital groups which can provide one’s full treatment for the major diseases in the basic package. Whether their choice will be to merge, – and this will become clear through the mechanisms of the compulsory health card – to join together in a functional union or to make a consortium, this will be recorded for each city and for each individual case,” said Moskov. He emphasized that this is done both – in the interest of patients and in the interest of doctors.