EKIP– Expert Club for Economics and Politics A Different Opinion
Like any other state monopoly, the healthcare sector has been notorious for its inefficiency for years, but at the same time, no government has ever undertaken the necessary reforms to decentralize it. The result of the lack of change is clear - an increasingly deteriorating quality of services, affecting mostly end users.
Antoaneta Lazarova
The new government also has no intention of addressing the urgent structural reforms, and will continue with the ineffective injection of money into the healthcare system, maintaining heavily indebted hospitals with low quality of services and inadequate clinical pathways. Again, there is no clear idea whether the splashing of money will lead to an improvement in the system. This makes the failure of this cabinet in the healthcare sector very likely.
The low quality of healthcare services stems primarily from the existence of a (partial) monopoly in the form of the National Health Insurance Fund (NHIF). The lack of competition in the sector reduces incentives for efficiency, while at the same time severely restricting the right of personal choice on the part of consumers. Breaking the centralization of the health insurance fund by allowing private funds to compete with it on equal terms in attracting insurers is the only way to seriously improve the quality of medical services.
There are different ways in which decentralization can be implemented in our healthcare system. For example, to have a basic package with a minimum mandatory health insurance that covers the most necessary services. In this way, insurers will compete on additional voluntary percentages that cover different services. Consumers will have the right to personal choice for which additional healthcare services to be provided. Another way is for the different funds to fully determine the healthcare service packages, which would give consumers complete freedom of choice, but would also require a greater health culture on their part.
An important problem of the health system is the lack of funding for hospital infrastructure and equipment, because the funds allocated from the budget are more for the activities in hospitals themselves, and not so much for the conditions in them. Thus, managers are left to seek funding through donations and applying for EU projects, which are often insufficient. Therefore, private funds will be another way to finance the hospital environment, as they can finance hospitals and negotiate with them at lower prices, which will improve services for the end user. Thus, the lack of funding from the state and municipal budgets will become smaller.
Although the income from insurance contributions is increasing, this does not necessarily mean an increase in the number of insured persons. The change is rather due to the increase in health insurance contributions from 6% to 8% in 2009, the increase in the minimum insurance threshold over the years and other measures, such as reducing the period for restoring health rights to three years, which encourages some people to pay a large sum in one go.
The graphs above show that the infusion of resources into the healthcare system has been increasing over the years. At the same time, the trend is that more and more people are stopping getting insurance.
- As of June 2013, the number of uninsured persons is about 2 million people.
- April 2012 - 1.5 million people
- May 2011 - 1.9 million people
- 2010. May - 1.4 million people
- 2009. May - 1 million people
The main reason for the situation is the increased unemployment, a consequence of the economic crisis that began in 2008, and the increasingly declining quality of health services, which discourages consumers from maintaining their health insurance status. There is also a large number of people who leave the country and stop contributing to the local insurance system.
The absence of clear criteria for assessing the quality of health services is another obstacle to the necessary adequate reforms. But both in the provision and in the assessment of the quality of services, the state monopoly does not have a sufficient incentive for efficiency. The incorrectly defined and interpreted indicators that are used can easily show good quality where there is too much inefficiency.
The quality of health services is measured by a number of qualitative and quantitative indicators. The following can be taken as indicators of the efficiency of the health system: life expectancy, total morbidity, total, as well as maternal and child mortality. However, these indicators can be easily manipulated. For example, it was common practice in the past to discharge patients from the hospital before they died. Thus, they do not fall into the overall mortality rate in the hospital and it turns out that a better quality of services is provided there.
The quantitative indicators used in assessing the health system are: number of hospitals, number of hospital beds, number of doctors, etc. These are just numbers that do not give a clear idea of the efficiency of healthcare. We may have many hospitals, but they may have poor infrastructure and too many accumulated losses, which shows them as inefficient.
The quality indicators for assessing the hospital environment, which are used in Bulgaria, cannot be of significant use in analyzing efficiency either. They are designed to distribute funds between hospitals according to the range of services they offer, and not so much to monitor quality. In order for a hospital to offer various procedures, it must meet certain criteria. For example, to have certain specialists - cardiologists, surgeons, etc. or specific equipment such as nuclear magnetic resonance, for example. This means that these quality criteria do not indicate the quality of medical services, but only what services can be performed.
Over the last few terms, the chairman of the NHIF has also been the deputy minister of health, thus the health fund serves the interests of the government rather than the citizens. A clear example of this is the transfer of nearly 1.4 billion leva from the NHIF budget to the republican budget in 2009; 100 million leva to the Ministry of Health (MoH) in 2012; 340 million leva to the MoH in 2011. Thus, the supposedly separate health budget is starting to fill other people's holes. Given that the financial situation of the health system in the country is far from flourishing.
Ineffective policies pursued by governments are the cause of the low quality of health services and the absence of adequate criteria for their evaluation. Therefore, without structural reforms in the health system, the injection of greater funding into the otherwise deficient health care will not lead to the desired improvement in the quality of services.
Sources:
