EKIP– Expert Club for Economics and Politics A Different Opinion
More than a week ago, a draft amendment to the Law on Medicinal Products in Human Medicine (LMHPHM) was published on the website of the Ministry of Health. In addition to the changes to the law itself, the transitional and final provisions of the draft make adjustments to 10 other laws related to healthcare. A similar case was made with the NHIF Budget Law voted before the New Year, through which changes were made to 23 other laws. In recent years, we have witnessed cross-amendments to laws for a variety of reasons. Some are related to urgent changes that must be submitted for discussion and promulgation as soon as possible, because they concern a narrow time frame on which certain stakeholders in the field depend. Others aim to fix texts that may arouse dissatisfaction among users in the system. Adopting them "at once" saves lawmakers the long discussions and justifications when submitting the amendments separately.
Important changes in medications
The draft law envisages the introduction of the long-discussed and criticized cost-effectiveness mechanism (a mechanism to ensure predictability and sustainability of the NHIF budget), which aims to counter and/or optimize overspending on medicines in the NHIF budget. Currently, this mechanism is regulated at the sub-legal level, with the arguments of the proponents being that its inclusion in a law will lead to clear prerequisites for its definition and implementation. However, what is the problem with this justification?
The pharmaceutical sector is one of the most regulated, but also one of the most dynamic. The mechanism has been in force at the bylaw level since the beginning of this year and at present there is still not enough empirical data collected on its long-term efficacy in relation to the needs of the system. A main problem, if the mechanism is introduced into the law, is that any change (which there inevitably will be) will have to go through parliament to be approved. This will create additional administrative burden and delay in an area where quick reactions and decisions are key to the well-being of patients.
Important changes for pharmacists
The problem of pharmaceutical care and the disproportionate dispersion of pharmacies in the country has been acute for years. The number of pharmacies in the country is growing, but they are mainly concentrated in large cities. People in small towns, together with their treating doctors, have found a solution to the lack of pharmacies, by purchasing medicines through the doctor, who subsequently delivers them to the patients, but this is only a temporary solution. The Law on the Pharmacy and Drug Administration envisages the creation of a national pharmacy card to address the disparities with the lack of pharmacies in small towns. The problem with such a card is the violation of the principles of competition and the limitation of the opportunities of master pharmacists to open pharmacies where they assess that there is demand. The texts also propose turning pharmacies into 24-hour pharmacies in places where there are none, in order to improve access to medicines for patients, and fines (between 1,000 and 6,000 leva) are envisaged for pharmacies that do not work at night. If these texts become a reality, pharmacists from small towns with one pharmacy will have to start living in it. The negative incentives will rather force pharmacists in these places to close the pharmacy or move it to the nearby regional town, which will create an even bigger problem for local residents and they will be left without day pharmacies.
Important changes in hospitals
For years, there has been talk about the need for privatization and closure of medical institutions. There really should be one, but this should happen after they are removed from the prohibited list and offered for public sale. Currently, according to NSI data, there are 346 hospitals in our country - 2/3 of them are state and municipal, 1/3 - private. The quantity is large, but the quality of the service is not good, especially when it comes to small settlements. Prime Minister Borisov's promises that during his administration hospitals will not be closed further complicate the situation, because credit is given to inefficient and sinking state and municipal companies. Now the bill introduces decentralization of privatization - state and municipal hospitals will be able to sell separate parts of the territory on which they are located in order to pay off debts and make repairs. And thus a corruption niche is created - anyone who manages a state/municipal hospital will have the opportunity to sell state property to third parties. There is no personal liability in this case, since the property does not actually belong to the director, but to the state/municipality, so it is in his interest to sell it at a low price, after promising a commission.
The text was published in issue 29/2019 of The Economist magazine, dated July 26.
