EKIP– Expert Club for Economics and Politics A Different Opinion
When it rains heavily, the first thing that emerges from clogged manholes is mud. In political terms, it can be said that populism takes the lead precisely in the years of severe economic and health crisis that we are in. Changes are inevitably coming, and they are of key importance. What the politicians' move will be and how it will be responded to in electoral terms remains to be seen. In the past year of 2020, representatives of political parties from the left and right spectrum have been practicing free writing on the topic of healthcare. The proposals range from unsubstantiated subsidies for inefficient medical institutions in financial and quality terms to the elimination of commercial companies in healthcare or obliging private entities to conduct public procurement. Others are pushing for reforms in pharmaceutical policy, under the pretext that medicines in Bulgaria are expensive with the argument for their stricter price regulation. The most radical dream of returning to the "Semashko" model and implementing a command policy in the healthcare sector. Dreams and wishes are a good thing, especially at this time of year, but let's return to common sense.
Banning commercial companies in healthcare? Bad idea!
Since everyone has the right to exercise their right to free expression, proposals like the above are presented as a panacea for the problems of the healthcare system. Of course, the right to free speech does not exempt you from the right to be wrong.
In general, the idea is bad, the reasons for this are that the abolition of the status of hospitals as commercial companies will allow their losses and inefficient management to be concealed. On the other hand, their function as a tool for political influence will be strengthened. On the third - subsidizing annually bankrupt companies is like pouring cans of gasoline on a fire. Returning to the last municipal elections - there was not a single mayoral candidate who promised privatization, consolidation or liquidation of a medical institution.
The problems will remain, the quality will be low, but taxpayers will pay more for it. Commercial companies mean more transparency about where and how the money is spent. Turning medical institutions into budget-supported ones will return Bulgaria to the mid-20th century. The latest amendments to the law on the state of emergency allowed the state, if necessary, to subsidize medical institutions with over 50% of COVID-19 beds opened. A similar practice is being implemented in other European Union countries, creating budget sustainability during a crisis.
How many ways do we pay for healthcare? Many!
It is wrong to believe that taxpayers pay for health only through 8% health insurance to the NHIF budget. In fact, every citizen pays for health in seven different ways - through taxes to the central budget, through local taxes and fees, through health insurance contributions, with official co-payments for medicines and medical devices, through regulated co-payments for activity and team selection, through voluntary health insurance and, of course, with payments "under the table". The problem with payment is rather concentrated in out-of-pocket co-payments, which are a high percentage, as can be seen from the reports of the European Commission - between 60% and 70% for medicines, between 15% and 20% for hospital care and on average between 25% and 30% for outpatient care. While the levels of co-payment for hospital and outpatient care are similar to the European average, the rate for medicines is twice as high, especially for those that concern the treatment of socially significant diseases, among which the most widespread is hypertension. It should be noted that, despite the recommendations, no action has been taken to date to reduce co-payments for patients, especially when it comes to medicines. Another case is payments for medical devices, but with the 2021 National Health Insurance Act, a mechanism was introduced to limit the growth of payments to the department. The NHIF has promised that the debate on co-payments for medicines will take place by the end of January 2021.
Formalizing the co-payment? Why not?
The symmetry of information is of utmost importance for improving the quality and price of health services. When it comes to a planned operation or activity, the patient has the opportunity to choose the medical institution, the team and possibly the medical device (if necessary). What is missing is a public price register from which each patient can choose the cost of their treatment, based on the possibilities they have. Any publicity of prices leads to competition, which inevitably optimizes the cost of treatment and the care it provides. On the other hand, such type of information allows for predictability of patient costs. On the third hand, it has an educational effect on what the real cost of treating the disease is. Any attempt to prohibit co-payments would lead to a "graying out" of the health economy, namely - to increase payments "under the table".
The damage from the pandemic to health and the economy will reverberate for years to come. COVID-19 is also triggering the effects that inevitably lead to more state intervention, both in the economy and in the health sector, something that is a harbinger of a new era of perceptions. Processes will need to be managed in advance, as well as risk management, so as not to jeopardize the interests of well-established and key market players, as well as the competition they create. The turbulence of the reshaping of the political map is starting to grow. While racial and ethnic populism has been on the agenda so far, what is coming is social and economic, and no country is safe.
The article was originally published in the newspaper "24 Chasa".
