After two months of vacillations, negotiations and hard work, the second right-of-centre coalition government of Prime Minister Boyko Borissov has apparently mustered enough self-confidence and courage to undertake some of the most pressing and tough social reforms; in fact it was for the sake of these same reforms that the coalition won the elections in October last year. It first set out to radically alter the pension system, parliament endorsed it but due to public and political resistance on all sides, the prime minister was compelled to accept a reform of the reform and its temporary freeze until the problems are cleared up and the discrepancies ironed out.

At the same time little by little the ambitious, dynamic and highly controversial cabinet minister, who has even been accused of racism – Dr. Petar Moskov –developed and decided to propose to the public and to the political forces a whole package of reforms that would radically change the existing health care system. That the system is in need of radical change is clear to see. Doctors, hospitals and the National Health Insurance Fund have not been concealing their displeasure at the way things currently stand and recriminations have been flying on all sides. We should mention here some dramatic facts that only go to show how deep-rooted the problems are. A little under EUR 2 billion is the sum envisaged for the health care of 7.3 million Bulgarians for the year, or some EUR 240 per capita of the population. The sum is in fact bigger as, for one reason or another, almost a quarter of the population has no health insurance. This money may seem quite a lot for conditions here in Bulgaria especially seeing as over the past ten years it has trebled. But against the background of the 9 percent of the GDP that the EU countries set aside for health care, Bulgaria’s 4 percent is highly insufficient. That may be the reason why Bulgarians are the Europeans with the shortest life expectancy and with a huge number of hospitalizations over one year – around 25 percent of the population. To these somber facts we should add that the average age of doctors in the country is over 55, that more than 60 percent of young doctors state they will seek professional fulfillment abroad and… promptly do so.

Current Health Minister Dr. Moskov seems determined to grapple the most pressing problems all at the same time and to resolve them swiftly and comprehensively. The deadline he has set himself is April – by then he should have submitted to parliament proposals for amendments to the laws. The reform-minded minister intends to replace and supplement the so-called French health care model now in place, starting with what is in fact a demonopolization of health insurance. Until now Bulgarians were legally obligated to pay 8 percent of their income as installments to the National Health Insurance Fund and, if willing and able, to pay for additional insurance in private companies. Following the model of the pension system, Dr Moskov is proposing the introduction of a second, additional pillar, supplementing the mandated package of medical services that covers 93 percent of major diseases, provided for by the Health Insurance Fund. The idea is for the supplementary pillar to be handed over to private health insurance companies. Furthermore he wants the accent in health care financing to be shifted from the state and private hospitals that have been mushrooming right and left, many of which are suspected of misappropriation, to primary healthcare i.e. general practitioners and private surgeries. Whether dividing the package up into three – basic, supplementary and emergency – will mean an increase in the installments by the people who are medically insured or what will ensue will be simply a redistribution of money inside the system is yet to be seen. Be as it may the healthcare budget for the year adopted by parliament clearly states that the healthcare installments will not be altered and will remain at 8 percent.

As the basic outlines of the new health reforms have gradually been coming into focus, the positions of the major political and social forces have also been taking shape. Conflicting, that is how the initial reactions can be described in a word. Some medical organizations approved of them, patient organizations have also stated their support. But before any concrete steps were taken towards the implementation of the reforms planned, the powerful and very influential Bulgarian Medical Association clashed with the Health Insurance Fund which it was supposed to conclude an annual framework agreement with, setting down conditions that the Fund found it difficult to stomach at the last minute.

Will the health care reform go the way of the reform in the pension system, which though endorsed and approved by parliament was halted before taking off under public pressure? Dr. Moskov is satisfied this will not happen because, unlike the hastily adopted pension reforms, the changes in the health care system will first be voted, discussed and endorsed by the professional organizations, the political forces and the public and will only then become effective. The energetic minister and his team will have to invest a great deal of effort and put in a lot of work because life and health are the things Bulgarians value above all else.

English: Milena Daynova