The healthcare sector faces some serious grey share, just like everything else in the country. Modest estimations say it is 20 – 25 percent. I.e. 500,000 – 850,000 Bulgarians have neither insurances, nor incomes that pay for medical services. It means this group doesn’t work and doesn’t pay any installments, but most often gets sick. This part of the population is treated at the expense of those who pay medical insurance installments. Of course, the state should solve the problem – it either should start paying for such people or the other option is to open hospitals for the poor. However, that is unlikely to happen and we are about to see why.

Just like any other budget that of the National health insurance fund has its revenue and expenditure segments. The first is formed in two ways – above all, via our healthcare installments, or 8 percent of our income. The sum will be some EUR 920 million. for 2016, or EUR 46 million more on 2015. The other part comes from the installments, paid by the state for the people insured. This sum is around EUR 500 million. With an average monthly salary of EUR 410, the Bulgarian pays about EUR 30 for healthcare. The state pays some EUR 10 for children and retired people. That is why the NHIF calls on the state to pay more.

Actually the Bulgarian citizen pays 60 percent of the healthcare expenses out of his pocket and NGO researches show that over EUR 1 billion are paid under the table. So, we have two budgets of the health fund and the second being grey. The state must admit that it cannot cover the needs of the healthcare system. The respective legal text should be removed, reading that the NHIF pays it all. It covers no more than 45 – 50 percent of the treatment activities. Thus the fund lies to the hospitals, the hospitals lie to it and the patients are the ones that suffer after all. A good idea would be a decision to be taken on the percentage, covered by the fund, with the patients paying for the rest. This is not social at all, however.

The so-called diagnostically-related groups have been discussed for a decade. The payment to hospitals can be done that way and not along the current clinical paths. Nothing has been done at the same time. However, it should be done sooner or later, as the clinical path requires certain tests and procedures without taking into consideration what has happened to the patient and his illness after all. All hospitals get the money and the patient is the one who suffers. Diagnostically-related groups view the health of the patient.

The politicians obviously have no strategy on the matter. The Healthcare Act has been amended 90 times in 15 years. The idea is money follows the patient, i.e. activities are covered. Money goes for structures within the current system. All the measures proposed by the now Minister of Healthcare Petar Moskov are related to hospitals. Most money goes there, but it should be reached at in emergency cases only. That is why funding is aimed at prevention and outpatient treatment across the developed countries. It is vice versa in Bulgaria. That is why the analysis of the World Bank for the healthcare reform reads: “The coverage of preventive healthcare services is low and the Bulgarians get hospitalized more often than the rest of the Europeans – it is a sign that the system doesn’t offer the right combination of services”.

So, the system is not reformed and will stay that way, until a brave man appears, resisting the opposition of those who want to keep the status quo for the purpose of draining the healthcare barrel with no bottom.

English version: Zhivko Stanchev