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October 7, 2014
The elderly people in our country are satisfied with the General Practitioners and pharmacists, because they in details and clearly explain them the diseases and drug therapies and are considerate and kind to them. This shows a study of the problems of the elderly in Bulgaria conducted by the newly created think-tank “Solidarity with elders”. The study is based on in-depth interviews of elderly living alone in the capital, it is combined with the country representative data on the problems of people over 70 years of age.
Part of the problems of the elderly in Bulgaria and the base for their possible solution were presented on the occasion of the International Day of the Elderly people on the 1st of October.
The survey data shows that only a quarter of the elderly people are able to visit alone their General Practitioner because of reduced mobility. Nearly 80% of people who regularly visit a doctor and pharmacy have more than one disease and take many medications.
Among the problems of the elderly are such as lack of circle of friends, difficulties associated with the lack of recreation areas in institutions, hospitals and commercial buildings. It is clear from the survey that leaving the home is also a problem for people over 70 years, because of fears of the state of urban infrastructure and the dynamics of the urban environment.
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Vyara Vragova of the patient organization “Type 2 diabetes” said that the General Practitioners neglect the problem of type 2 diabetes. According to her the General Practitioners “do not pay much attention” to the possible diabetic symptoms. “It is no secret that the medical check-ups do not actually take place”, she said. Vragova indicated also waiting for access to a specialist as a problem.
“The access to specialists is limited because of administrative procedures,” said the endocrinologist from Hospital “Alexandrovska” Dr. Natalia Temelkova. “At the moment due to different administrative procedures actually in type 2 diabetes the specialist is not required – something against which we professionals protest,” she said, adding that the next frame agreement must be changed. “The diabetes, I think, should be exclusive duty of the endocrinologists,” she said explicitly.
Dr. Temelkova presented statistics that about 435 000 people in our country with diabetes, which our health care system “knows” – the number of people who use the services of the NHIF. She said that a cignificant number of patients, however, buy their own drugs, especially in the early stages of diabetes and outside the register. According to her, the likely total number of diabetics in the country is about 600 000 people.
For 2013, the total number of people with diabetes worldwide is estimated at 382 million. She sais that about 175 million are undiagnosed, adding that according to forecasts by 2030 the number of people with this disease will increase by 40%.
Dr Temelkova said that 80% of the people with diabetes are from countries with medium and low economic development. Diabetes is the most common cause of blindness, chronic renal failure, for the non-traumatic amputations of the lower limbs. She pointed out that in these patients, the incidence of stroke is two to four times greater, and eight of ten diabetics die of cardiovascular disease.
On the occasion of the World Day against diabetes on November 14th in Bulgaria began a massive information campaign “Openly about Diabetes” with special focus on the balanced diet.
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The National Health Insurance Fund announced that on the last day of September National it received the funds for this July needed to pay the difference in user fee for pensioners to general practitioners and dentists.
From the beginning of this year the pensioners pay user fee BGN 1.00 for examination instead of BGN 2.90. The difference is covered by the state. For this purpose in the budget were allocated BGN 8 million, but medical professionals complained of delays.
The cash for overcoming the delay amounted to BGN 1 592 096.00 and was transfered from the budget of the Ministry of Health under a procedure established by law. They will be distributed according to the requests of the Regional Health Insurance Funds.
The press release of the NHIF noted that on August 21st of this year the Director of the NHIF Rumyana Todorova and the Minister of Health Miroslav Nenkov established rules for determining and providing transfers. On August 26th of this year the Fund sent a letter to the Ministry of Health regarding the need for transfer of funds for July, and in a letter dated September 11th of this year reminded that the transfer has not taken place yet.
On the same day the Director of the NHIF requested the assignment of cash for payment of the difference in the user fee for the outpatient care for pensioners for August 2014 also.
The press release reminds that the user fee payable for inpatient treatment in hospitals remains BGN 5.80 and is mandatory for pensioners by age and contribution period and for other health insuranced if they are not exempted from payment.
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The employers and the trade unions supported the revised budget of the NHIF proposed by the interim government. The social partners, however, strongly objected against the situation in health care, stressing that health costs have doubled in the last five years but the quality of service remains the same.
The revision provides for the Health Insurance Fund to use the currently available transitional balance within BGN 100 million. by the end of the year.
Health Minister Miroslav Nenkov explained that the money will be used in four areas: health insurance payments to hospitals and for medical care – BGN 50 million, for cancer therapy – BGN 15 million, for medical devices used in hospital care – BGN 10 million and for medicines for home treatment and diet food – BGN 25 million.
The minister stressed that the management of the National Health Insurance Fund did not want money simly to “meet the ends” of the budget by the end of the year, but thought in the direction of an attempt to compensate for this shortage.
The Director of NHIF Dr. R. Todorova stated that under the current regulatory framework cashier can not afford not to pay the work done, whether it was done qualitatively or not.
The CITUB proposed the NHIF to be divided into two funds: “Healthcare Insurance” and “Medical Assistance” as a measure to overcome the crisis. According to the experts by improving the collection of installments, the fund will have more money and it will be clear where they are going. Such separation of the cash flows will force the state to pay properly and at 8% instead of at 4% the insurance of eight groups of citizens, including pensioners and students, officials and prisoners. The Unions add that such a separation may be done and the health insurance of the concerned groups allocated to a new Executive Agency “Medical Assistance”.
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The Gerneral Practitioners can, without problems, report to the NHIF the Immunizations preformed in children despite the changes of the terms of their performance
There are no problems for the General Practitioners to report via the information system of the National Health Insurance Fund (NHIF) the immunizations, despite the change in the terms of the required immunizations for children (Ordinance amending and supplementing Ordinance No. 15 from 2005 on immunizations in the Republic of Bulgaria (prom., SG 54 from 07.01.2014, in force from 01.07.2014 years).
By letters dated August 7 and September 3, 2014 the Directors of the RHIF were informed by the Director of the NHIF of the changes to the Ordinance. Attached to the letters were a letter of the Chief State Health Inspector and an Order of the Minister of Health.
The amendments to the Immunization Schedule of the Republic of Bulgaria related to the changes in timing of the required immunizations are consistent with the reporting and payment of the required immunizations performed under contract with the NHIF. For this purpose, the Director of the National Health Insurance Fund – Dr. R. Todorova, has sent letters to the directors of the Regional Health Insurance Funds, which remind them again to inform the providers of primary outpatient care under contract with the institution.