Comments by Dr. Stojcho Katzarov, Chairman of the Board of Directors of the Center for Protection of Healthcare Rights.
People say: Hospitals are commercial entities and this interferes with medical care. Why and what hinders? No explanation given. It is not necessary. It become like spell, refrain that one hears before and after elections, between election and during the elections.
When something is repeated by ten people ten times and is written about in ten media, it no longer needs proof. It can comfortably fit in election programs. Even in management programs.
However, nobody yet has thought about what the hospitals should be if there are not commercial entities. Nobody mentions this. Or they rely on surprise? However, no one asks, as if everyone is aware. But they are not.
Well, what are the hospitals? Can they be cooperatives? Can they be civil partnerships? A legal non-profit entity?
In fact, the law now allows the hospitals to be register as cooperatives. Nothing prevents the Minister of health to re-register for example Hospital Alexandrovska, Pirogov, ISUL and all district hospitals as cooperatives. The law allows it. It allows the owners of any private hospital to become cooperatives. But they are not. And nobody does it.
The Commerce Act allegedly interferes because “it drives hospitals to be profitable”. Is this it? Then write a law that will lead them to be at a loss. But you do not want them to be at a loss.
The Commerce Act allegedly led the hospitals to accumulate debt. The hospital with the highest debt – BGN 120 million is MMA and it is not a commercial entity. Who is making it accumulate debts?
The hospitals could not register for VAT, so piled obligations. But please, please, hospitals are not registered for VAT, not because of, but in spite of the Commerce Act – due to restriction in the VAT Act. This saves 20% in costs to the NHIF.
The health is not a commodity. Of course it is not. No hospital sells health. They sell medical services. Unlike health, these services are goods. They cost money – for salaries, insurances, medicines, X-ray and ultrasound machines, surgical instruments, gloves, aprons, food for the sick, heating, fuel, electricity etc. And this has absolutely nothing to do with the Commerce Act. However the hospitals are registered the costs are costs and someone either the MH, the NHIF or patients themselves will have to pay, otherwise … Otherwise there will be no medical care.
“Drive the money changers from the temple.” No problem. Only that the temple does not switch on systems does not provide anesthesia, lithotripsy or extracorporeal circulation. In the temple people light candles, and lately they not even from wax.
The commercial companies may fail. So it is thankfully. Not only that, there is nothing wrong, but even it is very useful mismanaged companies to go bankrupt. However, one of the reasons there are so many hospitals in Bulgaria is that the state does not allow the bankruptcy of its own ones. Whether protecting them from creditors or subsidizing them, whichever. On the other hand, if the state was allowed it would bankrupt all private and most municipal hospitals. So far it has not succeeded, but attempts continue.
The real reason for the problems is not the commercial registration of the hospitals, but the state itself, through its organs the state hinders free competition and tolerates some over others.
The truth is that the commercial registration gives freedom to the doctors, no matter how restricted by a number of other provisions. Those who seek the annulment of the commercial registration really want – though not dare to say so – the Minister of Health again to become the employer of all doctors. They want a strict hierarchy, subjection, submission and obedience.
Logically, the power is bad only for those … who do not possess it.
The removal of the commercial registration of the hospitals will benefit only those in power. All others will lose. Most to lose – the patients.
At a meeting held last week the government approved amendments to the Regulation on calculation and payment of cash compensation and benefits from public social security related to the introduction from the 1st of January 2015 of an electronic medical certificate. This was announced by the press office of the Council of Ministers. According to the changes the data entered in the electronic register of medical certificates and decisions on appeal, should be taken into account in assessing the right and determining the amount of the cash compensations and benefits.
Regulated are the entities that present the data contained in the issued medical certificates to the NSSI – attending doctors and medical advisory committees through the medical institutions they are subordinated to.
The insurers and self-insured will no longer be obliged to check whether their medical certificates are issued in accordance with the legislation regulations. The requirement to attach the report of the Medical advisory committee or a transcript of the death certificate to the medical certificates of persons on leave due to death or serious illness of a mother of a child up to 2 years old will be dropped. In both cases, the documents will be collected automatically.
Specified are the beneficiaries and the documents for submission, and the starting point from which the period for payment of compensation is calculated, depending on whether the payment is made on the basis of the data in the issued medical certificates and the documents submitted in the relevant territorial unit NSSI, or on the basis of documents only.
The Agreement for cooperation for implementation of effective control over the funds in the field of interventional cardiology and cardiac surgery, was signed last week. The press center of the Fund announced that the Agreement was between the NHIF, the companies in cardiac and interventional cardiology and the national consultants in cardiac surgery and invasive cardiology, announced
The Agreement provides a framework for cooperation between the parties according to their competence, subject to the Bulgarian legislation and applicable regulations. The NHIF informed that within the framework of this cooperation the measures for effective spending of NHIF for cardiology and cardiac surgery are to be developed, while significantly improving the quality of medical services to patients.
“The Parties agreed on the understanding that it is necessary to perform regular and immediate quality control of the procedures performed by a joint expert body that has the power to draft amendments to the relevant legislation, such as:
– in the control activity of the NHIF to include monitoring of the number of the patients diagnosed, but not directed to cardiac surgery or interventional treatment in accordance with European practice and further discussion of these cases by so-called “heart team” including, a cardiologist, an invasive cardiologist and cardiac surgery specialist;
– in cardiac clinical pathways (CP) as a requirement to include a discussion of each case by the so-called “heart team”;
– to perform categorization of the invasive cardiology centers based on the material and technical equipment to perform complex interventions;
– to perform licensing of the high-tech activities – transcatheter valve replacement, aortic endoprosthesis;
– to create a joint expert and ethical working ethical body with clearly defined and disclosed rules of action and the power to impose sanctions. The expert body should have legality substantiated possibility to inspect facilities.” – announced also the Fund.
Today, with a charity campaign in favor of the Fund for treatment of children the Bulgarian Medical Association commemorates the Day of the Bulgarian physician. On October 19, the holiday of St. Ivan Rilski, our physicians traditionally celebrate their professional holiday.
At an official ceremony the winner of this year’s Physician of the Year Award was named – Associate Professor Krum Katzarov, Head of the Clinic of Gastroenterology in MMA.
“All doctors and all citizens can send SMS at a price of BGN 1 to charity, and the donated funds will be transferred directly to the account of the Fund for the children,” said the President of the Medical Association Dr. Tsvetan Raichinov:
“The reason behind this step is that the fund ran out of money and there is an acute need for treatment of children now. That’s why we established this number. The number is 17 777, the text is “fond”, written in Latin, and we hope our doctors and the Bulgarian people to respond.”
Dr. Raichinov commented on the fact that the Bulgarian doctors promote raising of funds for the treatment of children abroad:
“When the state obviously can not allocate the necessary funds, not enough is done, so that these children can be treated here in Bulgaria, and they have to be sent abroad. I think this is a reasonable step.”
The BMA wants the physicians to have guaranteed treatment for infections acquired in the workplace. This was announced by the Professional Association during the Congress of Nephrology in Hissar. The Medical Association undertakes the initiative entitled “Heal our healers”, the aim of which is with legislative changes to ensure payment by the state of the screening for the most common infections faced by physicians. It insists upon infection the medics to be guaranteed the most modern treatment. The doctors, nurses and dentists are among the groups most at risk of infection with hepatitis B, hepatitis C and HIV – said the deputy chairman of the Bulgarian Medical Association Dr. Cyril Elena:
“The initiative is intended to develop proposals for legislative changes in legislation allowing the medical staff to be treated with priority, with innovative products, with special treatments which would cover the risks associated with the profession. The second part of our activity is to use all our resources and contacts with the media, in order for this initiative to be disseminated and to seek public support – to convince the public that the health of medical professionals should be preserved or restored, so that we can assist our patients.”