EKIP– Expert Club for Economics and Politics A Different Opinion
Healthcare costs are increasing with each passing year, with the largest increase in absolute value over the past few years being observed in the hospital care item in the NHIF budget. It represents nearly 47% of the department's budget, having increased by BGN 750 million, or 58%, since 2014. It should be emphasized that the average hospital care costs for the European Union countries represent about 38% of healthcare budgets. Against the background of this accelerated growth in costs, the state is annually faced with the problem of bankrupt state and municipal hospitals, and the solution is usually to allocate money specifically through the budget of the Ministry of Health.
Closure and privatization?
Currently, there are 195 hospitals with public participation – 65 state and 130 municipal. 72 of them are on the prohibited list for privatization. The prohibited list contains a total of 178 companies, which means that hospitals form 40% of the enterprises "protected" from privatization. Viewed from the angle of the economy – this removes any incentives for the manager of the given hospital (as well as for its principal) to carry out reforms and optimize the resources it consumes, since at the end of the day it cannot be privatized or closed. So far, we have also witnessed complete "forgiveness" of the debts of such companies, as well as their targeted financing in violation of any rules that we adopted when we signed the Treaty of Accession to the European Community. The lack of a policy on privatization and closure of inefficient companies in the health system creates large disparities in terms of financing and implementation of quality medical care, which ultimately and mainly affects patients (taxpayers).
Another major problem of state and municipal companies is the lack of a mechanism for assessing their effectiveness and efficiency. A few months ago, an analysis was conducted by the National Health Insurance Fund and the Association of Municipal Hospitals, which showed that 50% of the revenues of municipal companies come from pathway No. 56 for the treatment of neurological diseases of various types. The name of each of these hospitals contains the letter M, which means multi-profile. Given that half of the revenues of this company come from one clinical pathway for one type of disease, their status should be changed, as should their administrative structure.
Restrictions on entering into contracts with new (private) hospitals
The purpose of introducing "moratoriums" on the conclusion of contracts with new medical care providers is to reduce the consumption of the already limited resources available to the NHIF. The problem is that state institutions, for some strange reason, decide that municipal and state hospitals, which are usually the ones that are poorly managed, are a better and more reliable contractual partner than private hospitals, which are rarely an example of poor management.
Limiting the scope of hospital providers' ability to operate directly limits patient choice. Competition is a fundamental principle when it comes to improving the quality of a service and reducing its cost. Reducing competition also reduces the natural economic incentives for a hospital to provide better, faster, and more timely care to its patients.
The idea that the money should follow the patient during the moratorium was quickly replaced by the decision that the NHIF and the Ministry of Health should decide where the treatment is better for him – in the state, municipal or private hospital. The problems that have been brewing for two decades are being "solved" by cutting the Gordian knot due to the impossibility of untying it. It is important to note here that if institutions want to really optimize their resources, this can be done through an analysis of the consumption of medical care, its optimization and timely deterrence of abuses due to wrong incentives, such as inflated prices of clinical pathways for certain manipulations.
The lack of timely information
The key information for healthcare is still transmitted in Excel format files between the local structures of the NHIF and the headquarters. Its timely processing depends on the fast and high-quality compilation of data, as well as the optimization of time. All these prerequisites are missing. That is why in March 2017, the project for a National Health Information System was launched with a term of 22 months. At present, none of its elements has been completed or implemented. Electronic healthcare in the country has collapsed several times in recent years after an otherwise secure start. A few years ago, the National Audit Office issued an audit indicating that over the years several unsuccessful attempts have been made to implement projects to create a National Health Information System (NHIS), with public procurements being terminated for various reasons, and in the current project their start has not even been given. Over the years, due to the termination of public procurements, 9.7 million were not utilized once. BGN financial assistance in 2012 and a second time BGN 12 million from a European program in 2014. These unsuccessful attempts show, according to the auditors, that "the overall organization of the process of planning and implementing e-health projects and public procurement is ineffective and needs significant improvement."
This article was originally published in "Capital"
