SUBJECT: THE CRISIS IN MUNICIPAL HEALTH

SUBJECT: THE CRISIS IN MUNICIPAL HEALTH

DEAR LADIES AND GENTLEMEN,

With the latest amendments to the Medical Establishments Act (amended, SG No. 85 of 2 October 2020), the members of the management and control bodies of the state and municipal medical establishments and of the medical establishments with state and / or municipal participation in the capital, are elected and appointed after a competition under the Public Enterprises Act. At the same time, according to Art. 20, para. 3 of the Public Enterprises Act, they may not be managers and executive members of the boards of directors and of the management boards of persons who work ex officio or by employment, except as lecturers in a higher school. This, in practice, means that doctors working in these hospitals cannot participate in the management of municipal facilities, and it will be necessary to appoint outsiders, which further aggravates the severe staff shortage of actually working medical staff in municipal hospitals.

In connection with the announced intention for collective resignation of the members of the Management Board of the Association of Municipal Hospitals in Bulgaria (a member of BIA), BIA reminds that at its joint meeting in September 2019 the management boards of the Bulgarian Industrial Association and the Association of Municipal hospitals discussed and adopted a firm position on undertaking radical urgent changes in the organization, management and financing of health care, above all - in the municipal health care system. In March 2020, the two organizations came up with joint proposals for emergency measures to increase the capacity of municipal hospitals to counter the spread of COVID-19 in Bulgaria.

The current state of the health system in the context of a pandemic confirms that:

Attempts to change health care to date have been characterized by low interconnectedness, continuity, consistency, transparency and consensus, which has blocked their introduction, posed significant risks to national security and widespread negative public attitudes;

No realistic priorities, general concepts and working models of changes in healthcare have been formulated and adopted. The decisions do not take into account the balance between health needs, set goals, limited financial resources and capacity of the competent state bodies and institutions.

Consolidation of the efforts and capabilities of the organizations of medical professionals, patients, social partners and the non-governmental sector is not sought.

The system is unbalanced in favor of the costs of hospital care and medicines compared to the necessary costs of pre-hospital care, prevention and prophylaxis.

It is delayed with the introduction of comprehensive electronic, which will cover in a common system all health care activities, regardless of their departmental subordination and principles of operation.

The position of BIA and SOBB is that it is necessary to adopt a concept for stabilization, rehabilitation and development of municipal medical institutions for hospital care, incl. changes in the status of some of the hospitals in emergency units, medical institutions for specialized, post-hospital and long-term care.

It is necessary to change the system of their financing so as to provide quality emergency medical care, clinical and laboratory tests, imaging and specialized consultative medical care outside the regional cities.

It is necessary to introduce a system of protected state and municipal hospitals at the regional level, so as to ensure continuity and accessibility of health services for the population in the respective regions.

We expect priority urgent measures to overcome the problems in municipal health care, which is really at the forefront not only in the fight against COVID-19, but also for all other health problems of the local population. We also call for legislative amendments to the Medical Establishments Act, which would exclude municipal medical establishments from the scope of the Public Enterprises Act with regard to the election and appointment of members of the governing bodies.

WITH RESPECT,

/ P /

RADOSVET RADEV

Chairman of the Board of BIA