EKIP– Expert Club for Economics and Politics A Different Opinion
This text is an analysis of the government's program in the field of healthcare for the period 2017-2021, published on 02.08.2017 on the website of the Council of Ministers here.
Prevention and treatment:
The over-financing of hospital care in the country has created the prerequisites for heavy lobbying in the formation of the budget of the National Health Insurance Fund (NHIF). Hospital treatment costs are increasing significantly compared to the delegated budget of hospitals. In this way, disproportions are formed in the financing of some state hospitals. The Bulgarian Medical Union has strongly advocated the abolition of hospital limits, due to the fact that hospitals are in constant deficit due to a large influx of patients and the fact that they cannot refuse treatment.
Investment in prevention and prophylaxis is one of the main components of financial discipline in healthcare. In its program for the period 2017-2021, the government intends to focus on the prevention and prophylaxis of diseases, with serious attention being paid to non-communicable chronic diseases (NCDs). These diseases include socially significant diseases such as diabetes, hypertension (high blood pressure), COPD (chronic obstructive pulmonary disease), neoplasms, etc. The question is whether the government will implement this policy in its entirety and whether, if successful, it will cut back on hospital care costs, which the Fund incurs in annual overspending and the need for budget updates.
Effective use of funds for medicines and demonopolization of the NHIF:
The financial stabilization of the NHIF includes stabilizing the budget and effectively spending funds for medicines. The government intends to rely on a pro-generic policy that will optimize the budget for the benefit of patients, as well as increase access to medicines for the most vulnerable groups of patients, namely those in a financially disadvantaged situation. A similar policy has been implemented for years in some of the largest economies of the European Union (EU) – the United Kingdom, Germany and the Netherlands.
The demonopolization of the NHIF, on the other hand, may prove to be a stumbling block for the government, due to the nature of the insurance system and the fact that a partially de-monopolized system already exists. If such actions are taken, the health contribution should be reduced from the current 8%, which everyone pays into the state budget at the expense of private insurance companies. Only in this type of demonopolization would it be real.
However, expectations for reform in the field are different - it is speculated that the government is working towards copying the pension model by creating a second mandatory private pillar for health insurance or an 8+2 model. With these 2% contributions providing capital for private insurance companies to operate with. However, such a policy cannot be called demonopolizing, because the main capital will again be in the NHIF, and an oligopoly will be created in the field of private insurance, which will benefit only some players.
Development of e-health:
E-government, as well as e-healthcare, has been talked about for years. The National Audit Office issued a negative audit report on the state of the e-healthcare system, which showed that it has been in the programs of each of the governments so far, and the work on creating a National Health Portal, which would centralize all information regarding health insurance in Bulgaria, is at ground zero. The separate information systems and registries in healthcare are not integrated and real-time data exchange between them is not taking place. So far, 20 million leva have been missed (not absorbed) under European programs, due to the poor administration of European projects by national health institutions, including the Ministry of Health and the National Center for Public Health and Analyses (NCPHA).
If the government keeps its promise and proceeds with the creation of an electronic healthcare system, this would be a path to solving problems such as: access to statistical data, access to information about healthcare services, access to patient records by any treating physician, and the possibility of remote treatment.
The other aspect of e-healthcare includes the introduction of an electronic prescription, which would facilitate access to medicines, as well as track how public funds are spent and what doctors prescribe. The introduction of such a prescription and the prescription of the medicine by INN (international non-proprietary name) would enable master pharmacists to actually practice their profession, providing them with the opportunity to offer all medicines of this non-proprietary name. We have a similar example in France - the pharmacist receives the INN from the prescription and provides the patient with the opportunity to choose his medicine according to his economic and brand preferences.
Overcoming regional imbalances:
The problem of regional imbalances is historical. Before 1989, doctors/dentists were assigned to certain regions and municipalities based on the needs of the local population. For the doctors themselves, this was both a plus in terms of training and a minus in terms of what the specialist wanted to do and whether he or she wanted to be “exiled”. After 1989, we have observed movements of large masses of people and depopulation of certain regions as a result of the poorly managed command economy during socialism, which created false incentives to reside in a given territory. The result has been increased urbanization and regional disparities.
After the Supreme Administrative Court (SAC) annulled the National Health Card, the situation regarding imbalances remains the same. The health card itself, as a centralizer of health services, is the wrong move to solve the problem of the lack of health services in certain regions, because it aims to commandarily determine where and what health services can be offered to the population. The lack of services indicates that doctors have no interest in going to a certain region, due to various factors. Instead of creating a negative incentive, it is better to offer positive ones such as tax breaks, administrative support for starting a practice, as well as opportunities for distance specialization.
The government's health program for 2017-2021 is a guaranteed failure.
Now, the basic model for managing the national economy is one that ensures the emergence of crises. With this state error, successful public health care is impossible.
For sustainable social prosperity with viable healthcare, it is necessary to implement a crisis-preventing basic model for managing the national economy.
Compare our problems with those of the British, the USA and Germany and the solutions accordingly. In my opinion, three payers should participate in the payment of health services, the health fund, the state budget and an insurer. This way there will be control over the quality and volume and price, of course.