EKIP– Expert Club for Economics and Politics A Different Opinion
After the latest upheavals in the healthcare sector, it is necessary for power to be taken over by an expert who can offer optimal solutions to the problems in the sector - ones that will not harm the budget and will optimize the consumption of money from health contributions to the extent that they meet the needs of the population.
What is the condition?
In view of the NHIF budget for 2018, serious problems are observed in two areas - hospital care costs and drug costs.
In hospital care costs, we observe an increase of 345 million, which seeks to cover this year's deficits, while also providing a buffer against a possible update of the NHIF budget in October 2018. As a percentage increase compared to the previous year, it represents 23%. The problem with the increase in hospital care is that the system has not been reformed and there is practically no analysis of whether more funds in hospital care improve its quality. The other problem with the excessive financing of hospital care is that it is at the expense of outpatient care, for which there is no money left. That is, we treat patients when they have already entered a late stage of the disease, instead of it being interrupted in conception. According to Eurostat data for 2015, Bulgaria allocates 4% of GDP for healthcare for hospital care and only 0.5% for outpatient care. In terms of ratio in the European Union, they are 3.4% for inpatient care and 2.2% for outpatient care.
The cost of medicines has seen a sharp increase of 200 million, which is a 29% increase compared to the 2017 budget. The problem in the field again concerns the lack of data-based reform. The moratorium on 17 new molecules, which was imposed by the government, is a temporary measure, not a solution to the problem. If the government wants to carry out a reform in the field - it could divide the budget for medicines into 3 parts - medicines for malignant diseases have already been allocated as a separate item, it is time to do the same with medicines without analogues, which are precisely these 17 new molecules. This will create competition between companies that produce originals, on the one hand, and on the other hand, they will not be able to take shares in the financing of medicines with analogues (generics), as a result of which access to treatment for many patients with socially significant diseases is increased. What we currently see in the NHIF is that it finances boutique products - about 100,000 patients are treated with 80% of the drug budget, and for the other 3 million patients, only 20% of this budget remains.
What are the short-term measures to solve the problems?
Next year, the government will need to focus on several aspects of healthcare reform if it wants to see real change in the system and improve quality at the expense of the annual increase in costs.
The path of these reforms is first: successful completion of the project for the creation and implementation of a National Health Information System, including electronic prescription and electronic health record. The collection of statistics from the healthcare system is key to implementing policies in the sector that are based on empirical data, and not on guesswork, as has been the case so far. By introducing electronic prescription, the reasons for the constant increase in drug costs can be traced and why some doctors prefer to prescribe a more expensive drug instead of treating the disease with a cheaper interchangeable generic. Other advantages of this system provide the opportunity to monitor hospital care costs in real time and to stop bad practices.
The second issue that the new Minister of Health should focus on is the implementation of an effective pro-generic policy, which includes educating patients, doctors and pharmacists about the benefits of generic drugs, which save resources first for the patient and then for the public fund. Another part of the pro-generic policy is data analysis and removing the “obsolete” original molecules, for which there is a generic substitute, from the Positive Drug List. The increase in the reimbursement rate for groups of drugs that treat socially significant diseases such as hypertension, diabetes, etc. by the National Council for Prices and Reimbursement is also a useful move that can save patients money.
The third problem that weighs on the system are state and municipal hospitals in a pre-bankrupt state – the solution for them is privatization and the transfer of responsibility from public to private. Any rescue of such hospitals with public resources gives the wrong incentive for others in the system – i.e. it literally says – “no matter how inefficiently you manage the hospital – the government will always be behind you to finance it when it goes bankrupt.”
What are the prospects for the system?
In view of the problems described above, phased reforms can be carried out within 2-3 years, the problem is that with each attempt at reform, someone's interests or someone's well-established financial convenience will be violated. If the Minister of Health wants to implement effective policies in the field, he must prepare for attacks from many sides, for this he should seek parliamentary and public support for his decisions. Each decision should be based on real data and be rational, at the expense of the emotional outbursts of various interested groups and individuals.
The article was originally published on puls.bg
