Date: 18.07.2019


Readed: 4759

Health Minister Kiril Ananiev officially presented his vision for the new health insurance model. It forsees the demolition of the NHIF, which will compete with private funds. We interviewed Prof. Dr. Grigor Dimitrov for a commentary on this topic, who is a member of the Supervisory Board of NHIF, Chief Director of BIA and VUZF lecturer.


Ananiev's proposal, which was presented, qualitatively does not differ from the ideas, which were already presented on the health care reforms last year. The new thing is that it is being transferred without taking into account our conditions and opportunities, a model based on the best practices of the EU countries. The proposal, at an abstract level, synthesizes the best practice of both countries with quality healthcare - Germany and the Netherlands. I am convinced that we have no conditions or opportunities to realize this model. It seems to me that after about 10 to 15 years, the conditions for its application could be created. This model can be afforded by countries with a greater economic and financial potential.

Germany and the Netherlands are countries that allocate substantial financial resources to health. Germany's GDP is 3 trillion and 250 million euros. They invest 14 percent of the GDP for health care, which means 360 billion euros. This resource provides around 4,900 euros for per capita health. In the Netherlands, with a population of 16.5 million people, 10% of the GDP is earmarked for health care - 75 billion euros or 4300 euros per person for health. Except in the form of subsidies for the provision of health care to certain groups of the population - disabled, people with severe diseases, low-income groups, etc. additional € 12 billion. Bulgaria allocates a public resource for health care, no more than 4.5% of the GDP - about 2 billion and a half euros or an average per person, with no extra payments of 375 euros per person for healthcare. Given, we have such an insignificant financial resource and the lowest income in the EU, could we mechanically adapt the health system of the rich countries in our context? The answer is that we can only do so when we have the same economic and financial potential to achieve this goal.

 No special analyses are needed to justify that any application of such models are associated with a significant increase in the cost of fees, reserves, and administrative and other servicing of the participants in the system. This will lead to the redirection for other purposes, and yet the insufficient financial resources currently available to the system. Thus, in practice, the resource earmarked for health, which is formed by 8% health contribution, will decrease, because part of it will go in a different direction, not for medical care. And the excess over any reasonable margin will increase. As a result, with the same resource, little health care resources will be allocated. This logically follows from the presented concept.

Again, a health model was presented without any important preliminary steps that were also discussed in the previous presentation of the model. Firstly, we do not have an estimate of what part of the basic healthcare package is financially secured by the available public funds. It is not possible to determine what its scope will be and who will have the obligation to guarantee it. Without such an estimate, one cannot go forward.

Can we make a health reform without the system's electronics? Minister Ananiev has the idea of ​​this happening by 2021, which means that nothing significant in that direction could ever be done. It is not possible to build a system of health funds without having the system electronized. Another big and unresolved problem is the valuation of the medical work and staffing of the health system. There is an existing proposal to build a new system that involves attracting new staff to serve it, while at the same time we are in acute need of doctors and nurses. I think these problems, as well as a lack of rationale and financial analysis, have raised thousands of questions in the operational plan that create a mistrust of the model.

The healthcare reform is a complex process that affects the interests of all subjects in the health system and requires radical changes in the organization and management of the whole health system. Such a responsible and extremely risky activity requires very serious pre-training of the society, attracting a large number of experts, who have to determine the philosophy and steps which have to be to be taken into consideration in the whole process of demonopolization.

 The main objective of the health reform in Bulgaria should be the creation of a liberalized and economically stable health system built on the principle of solidarity, which is oriented towards the patient. Societal expectations are oriented in the direction of creating a health system that is built on an acceptable balance between public regulation between the state and its market relations.

 A key point is to determine the role of the state in the organization, management and financing of the health system. Remember that we are a social state and the state is responsible for the health of the nation. The main mission and responsibility of the state is to regulate and manage the processes in the health system with the help of a system of mechanisms and specific instruments, in order to protect and guarantee the interests of the population for obtaining quality and affordable healthcare. After determining the role of the state, it is possible to determine the scope, rights, obligations and responsibilities of the social security system and its participants. The current reform suggests the transformation of a part of the health system - a health insurance without a concept of how the whole health system will change.

 It is logical to first understand the concept of changing the entire healthcare system and then, on that basis, we will logically get to the plausible model of health insurance. If we stick to this logic, we will be able to give a clear answer to the question of who and how will could take care for cancer patients, the disabled and the chronically ill, the children and the pensioners. Following such a logic, we will seek solutions to territorial imbalances in access to medical care, the disproportions in hospital care, lifting the role of outpatient care, drug policy, positive lists, etc. This is the only way to overcome the feeling that the state is abandoning the care of people's health and transmits this responsibility to economic subjects.

 I believe it is time to pay closer attention to good health, and that is why it is essential to attract key and eminent experts, to pool their efforts and using their partnership to prepare and carry out the reform. For these reasons, it is of particular importance to achieve a consensus among the political forces and to ensure continuity and consistency in the development and implementation of the health policy. To support this reform, each of us, as well as the society as a whole, should be informed of what changes are being offered, what their cost will be, and its benefits for every Bulgarian citizen.