EKIP– Expert Club for Economics and Politics A Different Opinion
The main picture
This year, healthcare costs increased by another 490 million leva, with the NHIF budget reaching 4.35 billion leva. As every year, the budget increases, with the percentage change compared to the previous year 2018 being 11%. This year, there is no change in the insurance burden, the health insurance remains 8%. This should not reassure self-insured individuals, because on the other hand, there is another increase in the minimum wage, which from 510 leva in 2018 will reach 560 leva in 2019. This also changes the minimum monthly health contribution, which was 20.40 leva in 2018, and for 2019 it increases to 22.40 leva.
The main items on which the money is directed are again hospital care, medicines and medical devices. In medicines, the increase is the largest compared to other items, with the difference with the previous year being 12%. The largest increase is in funding for medicines for the treatment of oncological diseases - by 37% compared to 2018. The second largest increase is in hospital care - by 10%.
What are the problems?
The increase in the NHIF budget was expected in mid-2018, after an overspend was again formed in the oncology medication item. The other major expense of the NHIF was in relation to payments with foreign funds, but long-term contracts are expected to be concluded there to repay the obligations.
The problem of overspending on medicines has been going on for years, and only in 2018, when their budget reached 1 billion, did the departments decide to react. Their reaction is late, but it is still a start, although not in the right direction. It all stems from the short-sighted state policy regarding the reimbursement of medicines for socially significant diseases and the failure to implement the rational pro-generic drug policy, which has been included in the programs of the ruling and opposition parties for years, but has never been implemented.
It turns out that about 70% of the NHIF budget is spent on 30% of patients, and the remaining 30% goes to 70% of patients. The patients with cardiovascular and cerebrovascular diseases are the ones who suffer the most from the lack of reform. They have to pay about 80% of the cost of high blood pressure medications out of their own pockets. This is where the large percentage of co-payments in healthcare is formed, as a result of which the European Commission regularly reminds us to reduce it to the average European levels (between 20% and 25%).
The problems in hospital care are deeper rooted – the lack of optimization in terms of clinical pathways and their overvaluation leads to the fact that for some specialties the pay is many times higher than for others. Also, a direct correlation can be seen between the prices of certain clinical pathways and the constantly emerging private hospitals with the same directions. Another connection that is being traced is the lack of staff for certain fundamental specialties (pathology, anesthesiology, etc.) and the overproduction of others (cardiology, etc.). The medical student, as a market entity, decides to specialize in what will bring him the greatest income after graduating.
What are the reforms?
The proposed healthcare reforms this year will go through the transitional and final provisions of the NHIF Budget Act, which is a common practice of the government for amending other laws in the last few years. The problem with these amendments is the lack of transparency and a broad public debate, because they require adjustments to 17 other laws. However, several steps in the right direction can be noted, concerning the centralization of the Fund for Treatment of Children Abroad and the Fund for Treatment of Adults Abroad, within the NHIF. Another step in the right direction is the separation of the budget for medicines - this will give greater clarity to users in the system, as well as to stakeholders, what they have at their disposal and will also create transparency regarding the transfer of funds from one pen to another.
Regarding medicines - the imposition of a cost-effective model is more than imperative, as far as the annually growing budget is concerned. The creation of an economic mechanism for the consumption of finances in the field is a step in the right direction, but it needs several additional conditions - electronic prescription, borrowing good European practices in the field of health technology assessment, and also the creation of personalized drug therapy for rare diseases. Regarding hospital care - the next step that should be taken is a ban on transferring money from pen to pen - this concerns both fiscal discipline in the sector and adherence to the initially established relations in the National Framework Agreement. Regarding collection - the next step is for the state to pay full insurance premiums for the groups that it is legally required to provide - state administration, military, police, children and pensioners. It is also necessary to resolve the health status of 720,000 uninsured people, who usually use emergency care services for non-emergency cases.
