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The Parliamentary Health Committee could not decide whether GPs should hand out universal access codes (UAC) to the NHIF electronic system to patients. This proposal was made by the MP from GERB Semir Abumelih and was passed among the amendments to the Health Insurance Act, which the Commission considered during its second presentation.

The idea of the MP provoked the sharp reaction of the National Association of General Practitioners in Bulgaria some days ago, who said that that they were not postal services to provide this type of service. The GPs announced that in order to perform this, they would have to be paid additionally for the work.

Meanwhile, during the discussion in the Health Committee last week, Abumelih noted that family physicians could play precisely the role of couriers between citizens and the NHIF. According to his proposal, they would be obliged to hand out to patients the UAC in question, in a sealed envelope, and the keep the receipts in a special form. Currently, to receive the code, citizens have to go to the RHIF, where it is handed out to them.

The President of the Bulgarian Dental Association Dr. Borislav Milanov took the floor on behalf of the professional organizations. He urged lawmakers to take into account the opinions of doctors and not to burden them with additional clerical work.

The MP from GERB Kiril Dobrev said that when the proposed text was to be voted, the MPs should take into account the opinion of the General Practitioners. According to him, they should not be obliged to perform the service in question. The Chair of the Health Committee Dr. Daniela Daritkova went on to ask who would pay for the organization of the proposed service.

In response, the Manager of the NHIF Dr. Glinka Komitov said the Fund could not prepare 7 million envelopes with UACs. The Deputy Minister of Health Dr. Boyko Penkov said that neither the Fund, nor the Ministry had extra money this year. According to him, if lawmakers adopted the proposal, an amendment to the budget would have to be made.

As a result, the MPs postponed their decision until the next meeting.

The NHIF does not fund hospitals, but the services provided to the patients who visited the hospitals, stated Dr. Glinka Komitov, Manager of the NHIF, in front of the media. He noted that this was the reason for having to make adjustments to some hospitals’ budgets. According to him, most patients go to those hospitals where there are highly specialized personnel and high-tech equipment.

“If a reputable doctor from a certain hospital last year, went to work in another hospital on the same or a different territory – in another location, patients would follow the doctor. They would not visit the medical establishment they had gone to up to that point any more, since they had not visited the hospital, but the reputable doctor – the good, highly qualified specialist. Not surprisingly, in some hospitals, such as the specialized ones, part of the patients from the Oncology Hospital in Sofia for example, have already been visiting a private hospital, as the good, the very good doctors from the Oncology Hospital in Sofia are now working in the private hospital. Therefore, this resource is not simply redistributed to a given hospital, but because more patients visit this hospital, because of the presence of its employed highly skilled professionals,” he explained.

Commenting the case of the additional funds for hospitals, Dr. Komitov said: “I will propose to the Supervisory Board to increase the hospital resources of 146 of all 364 hospitals in the country. This proposal will not be based on which hospital should get how much, but on the justified requests of the medical institutions. Some hospitals want BGN 16 thousand, others – 2 or 5 million. All this will be presented to the Supervisory Board. Our funds for hospital care were 1.3 billion, but the Law on the NHIF Budget has the opportunity to advance funds from the Health Insurance Fund Reserve in the amount of 10% of the total revenue, or BGN 301 million. Up to BGN 5 million could be spent on primary care, up to BGN 10 million – on specialized care, and up to 5 million – on medical diagnostic aid, while  hospital care is allowed to be given up to BGN 180 million from the reserve in advance ” .

Dr. Komitov said his greatest desire was for hospitals not to have determined budgets, but to got paid for all activities performed. He, however, noted that for this to happen there should be greater control. “We will pay for the respective amounts of activities, as long as they are done according to the respective prices we have agreed upon,” said the Manager of the NHIF. According to his words, the medical institutions should concentrate solely on the quality of their medical care for patients.

The NHIF can perform inspections only after the events, said Dr. Komitov. He noted that if a breach was caught in a hospital now, it could not be sanctioned immediately, but would have to wait for the activity to be reported. According to him, under these circumstances, no employee would account for that activity and would report double for another clinical path. This requires changes to the existing legislation. Dr. Komitov added that both types of control should merge – the financial and medical control. According to him, the control authorities should conduct inspections suddenly and impose sanctions immediately, without reporting the activity. “To have transparency, we need the NHIF to publish the inspection information every month on the site, with the names of the hospitals and the violations found,” said he.

The four ruling coalition parties reached a consensus to record in the Health Insurance Act that those Bulgarians who want to be treated under the National Health Insurance Fund will have to pay health insurance 5 years back. This was announced by the MPs from the coalition in the past week.

In order to have health insurance now, one has to have all the contributions that were due in the last three years covered. One is permitted to have three unpaid contributions. By introducing changes to the law, the Health Minister Dr. Peter Moscow has required defaulting payers to transfer all amounts due since the creation of the Health Insurance Fund in 2000 up to now, in order to have their health rights restored.

Senior magistrates, doctors and patients attacked the idea, arguing that the maximum period for back payment cannot exceed 5 years. They insisted the new period to fit the maximum. So in mid-April, the Reformist Bloc MPs filed a motion for 5 years’ insurance back payment.

“We will support the proposal of the Reformist Bloc “, said Dr. Daniela Daritkova (GERB), head of the Health Committee yesterday. The parties Alternative for Bulgarian Revival and the Patriotic Front were of the same opinion.

“We have put forth a similar proposal, according to which, if the amounts due for the last 5 years exceed BGN 150, they can be paid back in installments,” said Dr. Sultanka Petrova  from the Patriotic Front.

The Ministry of Finance did not agree. The institution of Vladislav Goranov did not support the proposal of the Reformers that government officials should pay for their own health insurance, as opposed to the situation now – the state paying for it. The reason was that such a change had to pass through tax laws and to be provided for in the annual budget.

Unexpected Effect

Since the Health Minister Dr. Peter Moscow announced his idea that Bulgarians should pay “tax” for their health obligations 15 years back, the revenues from contributions have increased, showed a notification from the NRA. This was emphasized by MPs from GERB. According to them, discussing the change, although it was not in line with our legislation and could not be accomplished, produced a positive effect.

The administration of exemestane significantly reduces the incidence of invasive breast cancer in postmenopausal women with moderately increased disease risk, showed the results of a study published in the New England Journal of Medicine.

Estrogens are involved in the normal mammary glands development, but their high circulating levels may increase the likelihood of breast cancer. Currently, the chemoprevention of breast cancer has been focused mainly on the selective estrogen receptor modulator (SERM) tamoxifen and raloxifene, which have anti-estrogenic effects.

Aromatase inhibitors suppress the estrogen levels in postmenopausal women and reduce the development of breast cancer in laboratory conditions. During the early research in this field, the non-steroidal and steroidal aromatase inhibitors reduced the development of contralateral breast cancer to a great extent, when compared to tamoxifen.

For example, after five years’ treatment with tamoxifen, the administration of letrozole reduced the risk by 46%, as compared to placebo. Preclinical models and clinical trials have demonstrated that exemestane is a good candidate for this indication.

The study MAP.3 was an international, randomized, double-blind and placebo-controlled study. It included 4560 postmenopausal women with a mean age of 62.5 years with some of the following risk factors: age> 60 years; five-year risk score on the scale of Gail> 1,66% (1,66% risk of developing invasive breast cancer in the next five years); previous ductal or lobular hyperplasia or lobular carcinoma in situ; ductal carcinoma in situ with mastectomy. Patients were divided into the following groups: exemestane 25 mg plus placebo; exemestane 25 mg plus celecoxib; and placebo plus placebo.

After the three years’ follow-up period it was demonstrated that the administration of exemestane was associated with a significant (65%) breast cancer risk reduction in the tested groups.

Exemestane had reduced the incidence of precancerous lesions as well (ductal carcinoma in situ, lobular carcinoma in situ, atypical ductal hyperplasia, and atypical lobular hyperplasia) which would have most likely lead to a further reduction of the invasive cancer in the long term.

This is the most significant disease risk reduction in the four largest breast cancer prevention studies. In the previous studies, tamoxifen and raloxifen reduced the disease risk respectively 50% and 38% after five years of follow-up. Subsequently, both drugs were approved by the FDA for breast cancer prevention in women with increased disease risk.

Experts hold the opinion that exemestane is a new opportunity for breast cancer prevention in postmenopausal women.

The analysis results show a favorable safety drug profile for this indication. The frequency of osteoporosis, cardiovascular complications and bone fractures were similar in the groups on exemestane and placebo.

For the three-year follow-up period 30% of those surveyed stopped taking the drug because of side effects, which was similar to thе clinical practice observations of aromatase inhibitors as an adjuvant therapy for early breast cancer.

Subgroup analysis showed that even with the intake of calcium and vitamin D, women treated with exemestane had lower bone mineral density (BMD) during the second year of treatment.

Based on the results of MAP.3, exemestane was included in the new practical guidelines of the American Society of Clinical Oncology in 2013 with the following indication: “Exemestane (25 mg per day orally for five years) should be considered as an alternative to tamoxifen or raloxifene for reducing the risk of invasive, positive for the estrogen receptor (ER +) breast tumors in postmenopausal women. The drug should not be administered to reduce the risk of disease in premenopausal women. “

June 14, 2015 marks the 10^th anniversary from the creation of the Department of Cardiac Surgery at the University Hospital “St. Marina” at the Medical University in Varna “Prof. Dr. Paraskev Stoyanov.” For this occasion, on the 12^th  and 13^th of  June, a Conference in Cardiology and Cardiac Surgery will be organized in Varna under the auspices of the Medical University in Varna “Prof. Dr. Paraskev Stoyanov”, the Heart – Lung Association, and the annual meeting Varna – Augsburg.

As a leading manufacturer of generic and patent medicines with a wide range of drugs for the cardiovascular system, Tchaikapharma High Quality Medicines AD will also participate with its own representative stand. There visitors will have the opportunity to learn about the latest developments in the field of cardiology and to obtain detailed information on the current portfolio of the company and our latest products registered on the Bulgarian market.