The online discussion was organized by the National Patients' Organization (NGO), in partnership with Capital and the Bulgarian Industrial Association.
The patient should be at the center of the health system and actively participate in the discussions at every step of future health reforms. Representatives of four political formations, registered for the upcoming elections for the 45th National Assembly - Ivan Todorov from the party "Izpravi se! Mutri vun! ”, Prof. Grigor Gorchev and Dr. Daniela Daritkova from the GERB-SDS coalition, Prof. Georgi Mihailov from the BSP for Bulgaria coalition, Dr. Alexander Simidchiev and Dr. Tanya Andreeva from the Democratichna Bulgaria ". They took part in a public online debate on "Healthcare at the Crossroads: Between Pandemics and Reforms", organized by the National Patients' Organization (NGO), in partnership with Capital and the Bulgarian Industrial Association.
The patient cannot be in the center of the health system without having his voice heard, Ivan Todorov from "Izpravi se! Mutri vun!” said. Dr. Daniela Daritkova assured that GERB will always be open for dialogue with patients because sustainable healthcare reforms can only take place when each discussed decision meets the prior approval of the nationally represented patient organizations. Dr. Alexander Simidchiev from Democrachna Bulgaria even proposed the creation of a special Commission for Health Consensus with the associated membership of patients, doctors, and non-parliamentary parties, to work under the leadership of the parliamentary health committee in the newly elected parliament. Prof. Mihailov from BSP for Bulgaria noted that the sector needs decisive steps towards change, "with less talk", and finally everyone agreed that the dialogue between the parties and the citizens should continue, no matter who will step into the future parliament and who will form the new government.
"The conversation cannot take place only in times of elections. The topic of healthcare should become a topic of professional discussions and public debate in the coming years. Many of the decisions in healthcare are a matter of expertise, but the ordinary citizen must be informed and convinced of the necessity of each decision, " Dr. Stanimir Hasardjiev, executive director of the NGO added.
"A national patient organization will continue to fight for the rights of patients all across the country and our voice will always be heard. But I ask future politicians to not only comment and debate, but also come up with real solutions; this is key to creating an adequate healthcare system." Chairman of the NGO Natalia Maeva pleaded.
The health care system should protect workers from diseases, and quickly solve health problems - it should provide access to treatment, quality services that reduce the time an employee spends on sick leave. These are some of the points that businesses expect from the healthcare system, according to Maria Mincheva, Deputy Chair of the Bulgarian Industrial Association. Complete digitalization is a key priority for employers, Mincheva added. "The approach is departmental at the moment, it's working in fragments, without coherence or any visible results. There must be solutions for the problems that employers have been concerned about for years - suspension of the employer's payment of the first three days of the employees' sick leave, reduction of the use of temporary incapacity leave, reform of the system of assessment of working capacity, which objectively reflects the population ", the Vice President of BIA summarized.
In the course of the discussion, the participants discussed some of the most pressing topics in the sector - the delayed digitalization of health services, the problem of funding, and the growing shortage of medical staff. On all issues, the parties agreed that urgent reforms are needed with clearly defined measures and deadlines for implementation.
Universal access to healthcare and digitalization
The global COVID pandemic has given impetus to e-health in our country and has become the main focus not only of the new political formations but also of the upcoming health reforms. The change can be a fact within a year if we have a politically declared consensus and a unified platform for reforms, Dr. Simidchiev from Democratichna Bulgaria claimed. According to him, digitalization is necessary to identify the sectors that need reforms and those worthy of receiving additional resources.
According to Ivan Todorov from "Izpravi see!" the digitalization of the sector is confronted with the patient's distrust and the medical staff's lack of digital competence. The problems can be overcome by organizing special public campaigns and additional training in universities of all health professionals.
"Some elements of e-health are already operational, but we have not yet achieved a complete data exchange. The problem comes in the practical realization ", Dr. Daritkova from GERB-SDS explained. According to her, the COVID information system, the e-hospital list, the prescriptions, and the electronic referral are indisputable achievements of the management but require a lot of work for their synchronization to a unified system and an electronic patient file. This will really put the patient at the center of the system, will provide more time for medical professionals, and will significantly improve the diagnosis accuracy, Dr. Daritkova said.
According to Prof. Mihailov from BSP for Bulgaria, e-health can be discussed only after the separate systems of the National Health Insurance Fund, the National Social Security Institute, the National Revenue Agency, the NSI, and even the customs start communicating with each other and functioning in a digital environment. The issue also concerns national security - the state has to provide proper conditions for e-health, the representative of the left is certain.
Outpatient healthcare and telemedicine
A huge part of additional healthcare costs in Bulgaria can be eliminated through proper policies aimed at preventing socially significant diseases and promoting a healthier lifestyle. All participants in today's discussion united around this thesis.
"A healthy lifestyle should be promoted in the way we advertise tourism," Ivan Todorov from "Izpravi se!" Mutri vun!” stated. According to him, the sector needs additional funds for new disease prevention programs, more medical practices to combat the risk factors that provoke them (alcohol consumption, smoking, overweight), as well as better state control over air, water, and soil pollution.
Prevention is the best investment in health, Dr. Daritkova from GERB-UDF claimed, and Dr. Simidchiev from Democratichna Bulgaria added that good prevention can save up to 60% of current costs in the sector. Prof. Mihailov from BSP for Bulgaria reminded viewers that the annual increase in the budget of the National Health Insurance Fund has no effect because it does not improve the quality of the offered medical service. According to him, to change the model of financing in healthcare, hospitals should "say goodbye" to their status as commercial companies, medicines should have a lower VAT, and patients should not have to pay extra for their treatment.
Human capital in healthcare
Bulgaria is an exporter of healthcare personnel because an average of 1,000 nurses and specialists leave the country every year to work abroad. As a result, 51% of doctors in Bulgaria are over 55 years old, and 40% of nurses are over 60 years old. Our country suffers from a shortage of 30,000 nurses and cannot keep young graduates because it offers them an extremely lower remuneration compared to abroad.
Doctors will stay in Bulgaria if the system provides them with the conditions for highly qualified work and adequate pay, according to Prof. Mihailov of the BSP for Bulgaria. According to him, young specialists should receive a starting salary of at least two minimum wages, and doctors with a specialty - at least three. However, salaries and job opportunities must be linked to specific commitments of physicians to the national health system and patient care, Prof. Mihailov added.
The representative of "Izpravi se! Mutri vun! ”Ivan Todorov proposed to develop systems for additional training of nurses as to distinguish specialized activities from those that they can perform independently. Healthcare does not make sufficient use of the resources and potential of paramedics, Dr. Tanya Andreeva from Democratic Bulgaria explained.
After the three-hour debate, however, political opponents united around the idea of putting aside their differences, at least in terms of healthcare, and continuing the constructive post-election debate until a consensus is reached on forthcoming reforms in the sector.