• Why the hospitals are commercial entities? And why not?

    November 3, 2014

    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.