[size=55:ox9ibjs6]Sofia echo 08 October 2010

Condition critical

On the eve of Bulgaria’s new Health Minister Stefan Konstantinov telling Parliament what everyone knew, that the country’s health system was in a mess, the European Court of Justice issued a ruling adding another burden to the National Health Insurance Fund (NHIF).

As he was about to be confirmed in office as the third health minister in the current administration (not unusual given that no government since 1989 has ended its term with the same health minister with which it began it), Konstantinov said that state hospitals had run up debts because of maladministration, access to specialists was limited, access to in-patient treatment was chaotic, there was no proper system to distinguish emergency cases from others, and costs of treatment were rising.

The two opposition parties that tabled a motion of no confidence in the Government on the basis of the health care crisis levelled similar charges. It was expected that the motion, scheduled for an October 8 vote, would fail for lack of support, and in any case the two parties – the socialists and Ahmed Dogan’s Movement for Rights and Freedoms – were targeted by the Government and its supporters as culpable for incompetent handling of health care when they had been in government.

Ailments and remedies

The Bulgarian Medical Association (BMA), which has been unrelenting in its criticism of the Government and in particular Finance Minister Simeon Dyankov and his deputy Vladislav Goranov, agreed to call off a strike planned for October 15 after Prime Minister Boiko Borissov announced that he would give health care more money and would act against problems in the management and funding of the NHIF.

Borissov said that he would remove Goranov from the NHIF supervisory board to enable doctors to draw up their own spending plans for the fund’s budget.

A deal was agreed between Borissov and the BMA, that the Government would provide 205 million leva to pay off the NHIF debt to hospitals and the association would drop its claim for a remaining 15 million leva in the fund’s debt to hospitals.

The announcement was made as Borissov said that he would no longer allow money that should be used for health care to prop up the payment of pensions. He added that he intended amendments to the Penal Code that would make non-payment of health insurance contributions a criminal offence.

Court in the act

Amid the drama, a ruling was issued by the European Court of Justice that the NHIF should pay for the medical treatment abroad of any Bulgarian who was unable to receive treatment in the country within the time normally necessary for the treatment, taking into account the patient’s current state of health and the probable outcome of the medical problem.

The ruling arose after the court was approached by Blagoevgrad resident Georgi Elchinov, who had in 2007 been diagnosed with a malignant cancer in his right eye. Bulgarian doctors had said his eye should be removed, but Elchinov found out that he could be treated in Germany and the eye saved. He underwent treatment in Germany and the eye was saved, but the NHIF refused to pay. In an 18-page judgment, the court found that this was out of line with European law.

Legal and illegal

On October 5, the Association of Doctors in Hospital Care said that more than half of the hospitals in Bulgaria had brought court action against the NHIF for money owed to them for the March-August period. The total sum involved in the court actions was a reported 150 million leva.

Allegedly, however, not every hospital was willing to go the legal route.

According to an October 4 story in Bulgarian-language mass-circulation daily Trud, a hospital in Omourtag in north-eastern Bulgaria had come up with a scheme to get money out of the NHIF by claiming for surgical operations that had not taken place.

The newspaper said that more than 400 people living in the area were "
shocked"
when told by prosecutors and financial investigators looking into the matter that they had been recorded as having had operations at the hospital. Allegedly, the scheme had drained about 500 000 leva from the NHIF.

The head of the hospital at the time of the alleged scheme, Dr Mehmed Ahmedov, denies any wrongdoing. He said that all operations had been documented properly and a check by the Medical Insurance Fund had found no serious irregularities.

Medical dossier

Summing up the situation in health care, Bulgarian National Radio (BNR) said in a special report on October 3 that experts who had been monitoring the health system for years said that they had expected these recent events.

"
The problems in the health system were either partly solved or simply handed down from one health minister to another, from one government to another. Anger is still running high among doctors. They complain that the health system is underfinanced. Patients complain about huge bureaucracy,"
BNR said.

With the latest resignation of a health minister, that of Anna-Maria Borissova who left on September 29 after only about five months in office, "
important steps in the reform such as restructuring of hospitals have been postponed,"
the BNR report said.

Daily newspaper Sega commented that Bulgaria could not continue to attempt health care reform on a trial and error basis. Health care, the paper said, was in a coma. Patients did not have access to basic services, doctors were underpaid and seeking jobs abroad and hospitals were facing closure.