News and Media

Prosecutors and medical auditors will audit the hospitals together

“Red Phone” between the Prosecution and the Ministry of Health will fight the attacks on emergency medics. This will create a direct channel of communication between the teams of Sotir Tsatsarov and Petar Moskov. This became clear after a meeting between the heads of the two institutions in the prosecution last week. The aim of the measures is to minimize the attacks on medics and to have effective punishment of those responsible.

According to the health ministry a total of 227 attacks on emergency physicians in the past year are reported. Of those, most – 142 in Burgas. Although the law in such cases is very strict and provides for imprisonment of up to 15 years, it is not applied in practice. Since mid-2013, when the attacks on medics were criminalized, there were only five sentences so far, according to the Ministry of Health. The heaviest of them is a suspended sentence of three years in prison for assault in Shoumen District. Another five cases and proceedings are ongoing. The expectation is that by creating a hot link between the Prosecution and the Ministry of Health the law will be applied more effectively.

Apart from cooperation in support of emergency medics, Tsatsarov and Moskov agreed to cooperate in cases of violations in hospitals discovered during inspections by the Medical Audition Agency. To this end the two agencies will sign a special agreement. It will be drawn up by a joint working group.

Parents are “against” the mandatory vaccines. In an open letter to the state institutions they insist the vaccination calendar to be voluntary.

Within only five days more than 3200 people have signed the petition for voluntary vaccination of children. Parents insist to have the right to decide whether and when to have their children immunized.

“Nowhere in the European legislation is said that vaccines should be compulsory. In Bulgaria, 9 of them are compulsory, we are more Catholic than the Pope”, said the patient’s organization “Together with you”.

In 16 European countries there are no compulsory but only recommended vaccines. In our country if a vaccine is not administered, fines follow and the children have no access to state kindergartens, parents specify. They hope for changes in the Health Act. And if the compulsory vaccination is not dropped out, at least the parents not to be fined.

The pediatricians have different opinion.

“The health culture of our population is still not at a level sufficient to enable individuals to assess the benefits and the negative effect of vaccines,” physicians insist. Professionals remind that the compulsory vaccines are against especially dangerous infections and are not selected randomly. Polio, tetanus, diphtheria – are diseases that have disappeared due to the fact that children have been immunized.

The government approved changes to the National Programme for primary prevention of cervical cancer in the Republic of Bulgaria 2012-2016, which provide for extension of the target group subject to immunization program by including 13 year old girls, informed the press office of the Council of ministers. A two-dose mode of conducting the immunization scheme is adopted, which corresponds to the changes in 2014 in the summary product characteristics of both vaccines used in the prevention of human papillomavirus oncogenic infections.

The new scheme will result in the release of financial resources within the approved budget of the Programme and will provide the parents, who missed the opportunity to immunize their daughters or parents, who changed their minds about the benefits of prophylactic immunization, the possibility of free immunization

The necessary resources to implement the Programme are at the expense of the approved budget of the Ministry of Health. The mechanism of financing the cost of vaccines and their administration by the National Health Insurance Fund through transfer of funds from the Ministry of Health is preserved.

With the adoption of the National Programme for primary prevention of cervical cancer in the Republic of Bulgaria 2012-2016, the country implement the recommendations of WHO to include vaccination against HPV in national strategies for the control of cervical cancer and became the 24th state in Europe to provide public funds for immunization against HPV, while retaining the recommendatory nature of the prophylactic immunization. The immunization coverage achieved with complete immunization schedule of three doses of prophylactic vaccine in relation to the number of girls targeted given in percentages is 24% for 2013 and 17.7% in the nine months of 2014.

Last week, the cabinet approved and will put to a vote in the National Assembly the proposed by the Minister of Health Petar Moskov changes in the Health Insurance Act related to hospitals, pay for medicines, collection of health insurance and others. The goals of the reform are twofold – to increase revenue in the system and make more efficient spending of the funds collected. Here are some of the proposed changes:

Measures against people without health insurance

The state gives a period of only six months to people without health insurance to pay their installments due for three years back to reenter the system. When this period expires, for the recovery of health insurance rights in practice the due installments will be from the commencement of the compulsory health insurance (i.e. from 2000), and not as per current legal regulations – for only three years.

The Minister of Health Petar Moskov explained that efforts by the NRA and the MF to collect health insurance installments are giving results.

The changes provide that the relevant health institutions after examination of an uninsured are obliged within three days to report to the NRA. Moscow explained that the state should know at any time how many are the uninsured.

The measure is put forward as part of proposals to increase the health insurance revenue and increase the revenue of the budget of the NHIF.

More stringent control over the quality of hospital services

The systematic violation of the requirements for quality of medical care will serve as a ground for termination of the funding from the National Health Insurance Fund (NHIF), proposes also the cabinet. According to the requested changes, the contract with the medical care provided can be terminated also when a systematic patients’ dissatisfaction is established. The NHIF is obliged to carry out a study of patient satisfaction with the health services covered.

Two packages of health services will be covered by the NHIF

The package of medical services covered by the Health insurance fund is divided into primary and secondary. The specific medical activities to be included in the packages will be regulated by the Minister of Health in an Ordinance.

The proposed changes reinstate the contractual basis in defining the methodologies for valuation and payment of medical activities, the volumes and prices of medical services, and arrangements for monitoring of the implementation of the contracts between the NHIF and the health care providers, as well as penalties for non-compliance. These relations will be negotiated in the National Framework Agreement (NFA) between NHIF and Bulgarian Medical and Bulgarian Dental Associations. This will enhance the participation of the professional organizations in determining the quality criteria for carrying out medical activities and in the treatment results monitoring.

The Arbitration Committees will be reinstated and they will review the opinions of the persons (health care providers) checked in case of established violation of the NFA.

The state will pay more for the health insured by it subjects

The proposed changes provide for gradual increase of the insurance income by 5% a year starting from 2016, on which the state will pay the health insurance installments to reach the minimum insurance income for self-employed persons. Currently the state pays only half of it, which creates conditions for underfunding of the system and accumulates deficit and affects the quality of health care.

The arterial hypertension (AH) is a widespread disease, which often occurs in combination with other pathological conditions, worsening prognosis in a patient with metabolic syndrome or type 2 diabetes (DT2), and damage to the target organs, such as microalbuminuria or renal failure (RF).

The combination of arterial hypertension and microalbuminuria or renal puts the patient in the high risk category for the occurrence of adverse cardiovascular events, and accordingly requires from the doctor a more aggressive approach for treatment and for combating the risk factors.

The recommended treatment of patients with hypertension and renal impairment includes blockers of the renin angiotensin aldosterone system (RAAS), angiotensin converting enzyme inhibitors (ACEi) or ARB, because these drug classes prevent onset and/or slow the progression of nephropathy. The side effect profile of RAAS blockers, which determines the tolerability and the compliance with the therapy, provides advantage to angiotensin receptor blockers (ARB).

For treatment of arterial hypertension eight ARBs are available: azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan и valsartan. They differ considerably from one another in terms of their pharmacokinetic and pharmacodynamic properties.

Telmisartan has the longest half-life (approximately 24 hours) and the highest affinity to the type I receptors of angiotensin (AT) II. Furthermore, its lipophilicity is higher compared to the other ARB, which implies a larger volume of distribution and a better penetration into tissues.

An additional effect of telmisartan is its function as a partial agonist of the peroxisome proliferator activated receptor gamma, leading to an advantage of the drug in patients with insulin resistance and impaired glucose regulation (DT2) in association with hypertension.

The specified characteristics of telmisartan are expressed in several clinical advantages (e.g., long-term control of arterial insufficiency – BP and cardiovascular protection), which makes the medication particularly suitable for the treatment of hypertensive patients with DT2.

VIVALDI (VALsartan in hypertensive type II Diabetic patients with overt nephropathy) provides the same degree of Nephroprotection as telmisartan and valsartan in diabetic patients with overt nephropathy, while in the same patient category the ability of telmisartan to reduce proteinuria is higher than that of losartan, despite the similar reduction in the values of BP with both medications.

Telmisartan has proved its efficiency in the absence of hypertension. The study ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) covers 25 620 patients with vascular disease or DT2 and evidence of organ damage that were randomized for treatment with telmisartan, ramipril, or a combination of both medications.

ONTARGET shows that both RAAS blockers are equally effective in influencing the primary endpoint (the combination of cardiovascular death, myocardial infarction, stroke and hospitalization for heart failure), but telmisartan is better tolerated.

Based on the results of ONTARGET, telmisartan is the only ARB with an indication for the prevention of cardiovascular disease regardless of the values of BP, including in patients with DT2 with renal impairment.

Tchaikapharma High Quality Medicines Inc. produces telmisartan under the trade Telsart.

Telsart is in the NHIF list with the following code and price:
Telsart 80 mg x 28 tabl. – CG201
Free sale price – BGN 5.64
Reimbursement – BGN 2.64
Additional payment by the patient – BGN 3.00

Telsart has the lowest price compared to all other competitors on the market – the additional payment under the NHIF is only BGN 3. For other telmisartans the patient has to pay between BGN5.15 and BGN 8.25. Estimated on the number of tablets Telsart again has the lowest price – BGN 0.11 per tablet.

For more information see here:
Telsart