What does the European Commission recommend to us in healthcare?

In the last few days, there has been a lot of talk about the recommendations of the European Commission (EC) regarding the 2017 European Semester and the report on the progress of structural reforms in Bulgaria. In the section "Healthcare", the report emphasizes the following main problems of healthcare in the country: limited access, insufficient funding and poor efficiency.

It is important to clarify in this case that the reforms in the field of healthcare have nothing to do with the macroeconomic imbalance procedure, but with the specific recommendations based on the National Reform Program.

Insufficient funding:

The issue of insufficient funding can be addressed in three ways:

• Not everyone pays

According to the latest data from the National Revenue Agency in 2014, the number of uninsured people in Bulgaria was 2 million. Compared to a population of 7 million, this is approximately 30% of uninsured people . The other group that falls into this category are representatives of the state administration, including the military and police. According to data from 2016, the administration numbered approximately 136 thousand people. The state covers the health insurance of these people, but is this exactly the case? In this case, it turns out that the state is taking everyone's money to pay for the insurance of these 136 thousand, which in itself is the effect of moving "from empty to empty."

• Health insurance is low

The increase in health insurance contributions from 6 to 8% in 2009 brought more money into the NHIF coffers. The purpose of this 2% reserve was the smooth transition from a monopoly single-payer model to a public-private model of health insurance (such as exists in Switzerland, the Netherlands and other countries in Europe). This much-anticipated and necessary reform did not happen due to weak political will and the fact that the state preferred to leave its hand on this resource. The same resource was later used to “fill holes” in the budget of the NHIF.

• Money is not being spent optimally

The healthcare budget has grown tremendously since the establishment of the NHIF in 2001 to the present day. Since 2009, the budget has grown by 39% or approximately 1 billion leva to reach 3.45 billion today. Despite the annual increase in the budget, the efficiency of health insurance has not increased. There is a lack of optimization and control over hospital care costs and drug costs. Referral fraud in the system and expensive drugs for which there are cheap substitutes are the basis of the growing budget.

Despite the annual increase in the NHIF budget, the efficiency of health insurance has not increased.

Limited access:

Bulgaria ranks second in Europe after Cyprus in terms of the percentage of co-payments by households, according to Eurostat data. Co-payments for medical services in the country are around 46%, including co-payments for pharmaceuticals and medical devices. Co-payments also have a positive side: they have an educational effect on the patient, so that they know how much their health care really costs, and they also aim to control health spending by the provider. However, the problem with access is rooted in:

• Drug policy

It is not true that the prices of medicines in Bulgaria are high, they are actually the lowest in Europe. The problem is the percentage (%) of co-payment by the patient, as well as the fact that the system of selection of medicines for PLS is not optimized. Medicines with the same effect are allowed in diametrically opposite price ranges.

• Hospital care

The over-financing of hospital care in Bulgaria creates the vicious practice of every patient being hospitalized for illnesses that they do not need or do not have. Hospitalizations are in most cases “on paper”, and the patient does not even suspect it. The budget for hospital care increases annually, and in 2017 it amounted to 1.5 billion leva. The Bulgarian Medical Association and the National Health Insurance Fund requested an update of the budget in May again in the hospital care part. For comparison, outpatient care in 2017 had a budget of 630 million.

In conclusion, it is good to say that the EC report shows the problems of the system, but does not provide specific solutions to these issues. These days, many ideas have been heard in the public space on how to address the problems described therein, all of which include more state intervention in the field, an increase in health insurance and increased regulations. These measures are no different from everything that has been done in the system so far and contributed to its collapse. It is time for a new strategy in health insurance – liberalization, optimization and simplification.

Източник на изображенията: Google

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