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People with cancer, mental health and chronic skin diseases will be receiving all necessary therapies, diagnostics, medicines and procedures in one place – a large hospital in the area.

The Health Ministry will be closing the dispensaries for the respective diseases and they will merge with general hospitals, confirmed the Health Minister Dr. Petar Moskov in front of the Parliamentary Health Committee. This will be done through amendments to the Medical Institutions Act, discussed by the Committee. Among the reasons was mentioned the duplication of structures and activities in dispensaries and hospitals, making the existence of the current oncology centers, mental and skin disorders “pointless”.

The merger aims patients to receive combined services in one place, and not to be sent for everything to different structures, explained Dr. Moskov. He described the situation of the patient as “a small animal in the jungle among the predators, where there is no way for him.” The liquidation of dispensaries is also a recommendation of the World Bank, said the Deputy Minister Dr. Vanyo Sharkov.

The intention of the Health Ministry created tensions among dispensary patients. “The monitoring of these patients continues for life. In a merger of oncology centers with general hospitals – who will be committed to this long term? The creation of large structures will worsen and commercialize the treatment of patients,” said Dr. Parashkev Tsvetkov, a surgeon in the Plovdiv Oncological Dispensary.

The Oncology Clinic in Blagoevgrad took part in protest demonstrations last week. Doctors from the hospital “St. Mina” were supported by the Mayor Dr. Atanas Kambitov and the President of the Municipal Council Radoslav Taskov. “We do not agree with the proposals of the Minister. As a physician and a mayor, I am against the amendments to the Medical Institutions Act. The Oncology Hospital is municipal 100%. The municipality has invested in it BGN 1 million – separately from the operational programs. The changes will not improve the treatment quality,” explained Mayor Kambitov. “There is no way to legislate changes so that municipal property becomes state property without the decision of the Municipal Council, and there has been no such decision,” specified Taskov.

“This is a good step by the Health Ministry, as most clinics in the country are hollow structures. However, there is a real problem with the property – in most cases the dispensaries are municipal and cannot be transferred into state structures,” explained Prof. Valentin Ignatov, Head of the Association of University Hospitals.

The idea of the Health Ministry regarding the merger of dispensaries and hospitals is to take place within a year.

Hospitals will receive nearly BGN 15.2 million more by the end of the year, informed reporters the member of the Supervisory Board of the NHIF Dr. Vanyo Sharkov last Wednesday. He explained that the Supervisory Board at a meeting has made a decision the university hospitals budgets to be increased by 2%, while the budgets of all others who provide emergency services – by 1%. A day later it became clear that in addition to the initially announced 146 hospitals, which will receive more funding, over 70 more hospitals have submitted applications. The money will be deducted from the reserve of the NHIF.

“It all is based on the decision and what we proposed at the previous meeting – to increase the budgets for providing emergency medical care. The operational management of the NHIF provided the lists and the distribution was carried out accordingly. What the operational leadership offered, we have adopted,” said the member of the Supervisory Board.

Dr. Sharkov said that “Pirogov Hospital” will receive most additional resources – about BGN 1 million. “University hospitals and hospitals with emergency consultation wards include: ‘Aleksandrovska Hospital’, ’Pirogov Hospital’, The Military Medical Academy, The Medical Institute of the Interior ‘St. George’, and ‘St. Marina’, “ he replied to the question which hospitals come after “Pirogov Hospital”.

The Director of the NHIF Dr. Glinka Komitov noted that the operational management of the Fund will offer additional funding only to hospitals with motivated demands. According to his forecast, in order to satisfy the demands of these hospitals, about BGN 50 million would be needed. Realistically, however, the allocated amount would be much less, said the Director of the NHIF.
The Supervisory Board of the institution is expected to examine these proposals on May 25^th.

The Health Minister takes on the medicine procurement in hospitals, announced the Council of Ministers in its Draft Decree. It was published on the website of the Ministry of Health for public comment.

In his new activity, the Minister will be assisted by a new unit in the Department, which will be created for the occasion – the “Central Unit for Negotiation and Administration.”

As a central authority, responsible for procurement in the “Healthcare” sector, the Minister will plan, prepare and carry out medicine procurement procedures. He will also be concluding framework agreements on behalf of hospitals.

Based on the concluded framework agreements, hospitals will determine the contractor using electronic auction and will conclude individual agreements, envisages the document.

The Minister will have the power to supervise the implementation of the framework agreements in relation to their compliance with their conditions – prices, quantities, deadlines and more.

The project also includes the possibility, if necessary, the Health Minister to conduct procedures to conclude the framework agreement on behalf of hospitals, through electronic auction.

One year after the Decree comes into force, the Health Minister has to provide conditions for conducting an auction through an integrated information system – an online platform for e-commerce needs of hospitals – indicates the text.

Until the conclusion of the framework agreement under this Decree, the medical institutions will provide their medications under the previous order, and the existing framework agreements and contracts with the same subject, concluded by hospitals’ management, will retain their validity for the period for which they have been concluded, except if terminated before the expiry of their term, it becomes clear from the draft document.

The change will result in time savings, administrative and financial resources for the hospitals and will reduce drug prices, are the motives of the Health Ministry. Furthermore, the reorganization will enable a faster and better response to the needs of hospitals, the presence of stable contracts and easing the system responsible for appeal procedures, according to the Department. According to them, the introduction of e-procurement will also facilitate the participation of all wholesalers, who are listed in the register for holding an authorization for medicines wholesale, and will increase the competition and improve the contracting sector conditions.

The extended use of electronic means and resources and the integration of the platform with the existing electronic records will contribute to the full publicity and transparency to effectively confront and prevent corruption in the sector, is said in a statement.

People between 18 and 49 years of age with isolated systolic hypertension (ISH) have increased risk of death from cardiovascular causes or ischemic heart disease (IHD) according to the results of a study published in the Journal of the American College of Cardiology.

The authors used a database of patients from 1967 to 2003 and evaluated the risk of developing cardiovascular disease (CVD) in the presence of ISH, defined as systolic blood pressure (SBP)> / = 140 mmHg and diastolic blood pressure (DBP) <90 mmHg in men and women under the age of 50.

27,081 participants were classified into five categoriesm, based on the values of BP: optimal BP (SBP <130 DBP <85 mmHg); high normal BP (130-139 / 85-89 mmHg); ISH (SBP> / = 140 mmHg and DBP <90 mmHg); isolated diastolic hypertension (IDH; SBP <140 and DBP> / = 90 mmHg) and systolic – diastolic hypertension (SDH; SBP> / = 140 mmHg and DBP> / = 90 mmHg).

According to this distribution, 53% of the women had optimal baseline BP and 13% – ISH, while among men – around 25% of the participants fell into each category: optimal blood pressure, high normal BP and ISH. Patients with known coronary artery disease and those taking antihypertensive medications were excluded.

The results showed that after 31 years of follow up the participants with baseline ISH were at increased risk for CVD and CHD mortality as compared to those who had optimal or normal blood pressure or high IDH. The relationship described was more pronounced in women. The risk in patients with ISH, however, was lower than that in patients with SDH.

Up to that point ISH at a young age had not attracted particular attention as a risk factor, but the data from this study showed that ISH was associated with an increased risk of CVD and mortality.

Since the frequency of hypertension, obesity and lipid profile disorders among young people have been increasing substantially, early intervention in the course of the disease and the promotion of a healthy lifestyle could significantly influence the future incidence of adverse cardiovascular events.

According to the Guidelines for the Management of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension (ESC / ESH), the preferred antihypertensive drugs for adults with ISH are calcium channel blockers (CCBs) and diuretics with class indication ΙA.

Some meta-analyzes suggest that CCBs may be more effective than other antihypertensive classes for stroke prevention (perhaps precisely because of the favorable influence of SBP, whose values are closely associated with stroke risk).
In addition, this class of drugs has been shown to lower the central aortic pressure, improving the endothelial function, and it also has antiatherosclerotic effects.

Ireland, the United Kingdom and Albania are the first three countries in Europe in child obesity. Bulgaria is fifth, according to a study published at a Congress on the problem in Prague. The study has been conducted with the participation of the World Health Organization (WHO) based on data for children aged up to 5 years in 32 countries of the Old Continent.

In Ireland, 27.5% of the children under the age of 5 are fat or obese, while in the UK they are 23.1%. Albania follows with 22%, and Georgia – with 20%.

In Bulgaria 19.8% of the children aged up to 5 years are obese. Spain follows with 18.4%. At the opposite pole are the Czech Republic – with 5.5 percent, Belgium – with 7% and 8% – in Sweden. Italy and France are in the middle of the table, respectively by having 10.2% and 11.4%.

Another study, presented at the colloquium in the Czech capital, concluded it was more likely that obese children leave school early compared to the ones with normal weight. 56% of overweight children under the age of 12 regularly attend school. This applies to 76 percent of their other peers.
According to the WHO estimates presented in Prague, by 2030 Europe will be facing a large scale obesity epidemic among its working-age population.