site.btaProject Proposes Medical Prices to Be Negotiated between Insurance Funds and Healthcare Providers

July 15 (BTA) - At a national round table on Monday,
Health Minister Kiril Ananiev presented a new healthcare model
to legislative and executive branch representatives,
associations, professional and patient organizations, scientific
 circles, trade unions and directors of medical institutions.
Within the proposed framework, healthcare service prices will be
 agreed upon between health insurance funds and healthcare
providers.

The health insurance contribution will remain 8 per cent, but
people will be able to decide whether to transfer it to the
National Health Insurance Fund (NHIF) or another fund. If they
do not make a choice themselves, they will remain with the NHIF
or will be automatically allocated. The funds will not be
allowed to select people based on certain criteria or on health
status, Minister Ananiev assured. Subscription to a fund will be
 voluntary, and a fund change could be made once a year. Health
contribution funds will be distributed by the National Revenue
Agency, transfers will be monthly and will be managed by the
health fund. Information about the process will be available to
subscribers. If the health fund goes bankrupt, the citizens will
 be able to enroll in another one at their own choice.

Funds participating in the system will be subject to regulation
under European legislation. The NHIF and private funds will be
determined eligible under EU regulations and will compete on an
equal footing, said Kiril Ananiev.

The Health Ministry will determine the base package of
healthcare activities that will be covered by the mandatory
health contribution, Ananiev said, adding that the Ministry will
 also be responsible for registering and licensing medical
treatments and drug policy, with centralized public procurement
for medicine. It will also determine medical standards and
coordinate staff specialization policy. Sectoral organizations
will draw up rules for good medical practice. Hospitals will be
able to form prices outside the base package, which will be
covered by health insurance or by patients.

This health insurance model project entitles patients to a
health fund and a healthcare facility, provides for competition
among insurers, Minister Ananiev noted, adding that a better
quality of treatment is expected, along with better control of
the system and improvement of prevention efforts. He explained
that this is the way to eliminate non-transparent and
unregulated payment for medical services.

"This is not a final decision, I look forward to constructive
proposals," said Minister Ananiev to the participants of the
round table and stressed that it is time "to give answers, not
just ask questions". "This will be a system for future
generations, and I do not want to force one or another option,
but to create a good result with mutual efforts," he said.

Deputy Prime Minister Mariana Nikolova praised the participants
in the round table, noting that starting such a discussion is an
 urgent priority. "This round table is proof of dialogue and
transparency and shows how decisions are made in the Council of
Ministers," added Nikolova.

At the national round table, Bulgarian Medical Union Chair Dr
Ivan Madzharov commented that the medical package, which is
currently covered by an 8-per-cent health contribution, is of
too big a volume. According to Madzharov, it is unacceptable for
 certain medical establishments to negotiate on their own with
powerful insurance or social security funds, as is envisaged by
Minister Ananiev's proposed model. Madzharov added that
patients' freedom to choose where to be treated will probably be
 limited, if the funds choose on their own with which medical
establishment to sign a contract.

Andrey Damyanov, representative of the patients in the NHIF
Supervisory Board, noted that demonopolizing the Fund will
definitely lead to increased expenses for healthcare. "We ask
that medical standards and diagnostic algorithms be the basis of
 patients' treatment," he added.

Mimi Vitkova, representative of an insurance fund, said that
"demonopolizing the NHIF is not something bad". In her words,
however, there must be state supervision, including of the
competition, which is provided for by the new model. "If our
State believes it will shift responsibility to other insurance
or social security associations, this is a wrong approach," she
added.

Movement for Rights and Freedoms (MRF) MP Nigyar Dzhafer
commented that for 15 years, the MRF has been insisting on
demonopolizing the NHIS's powerful monopoly, but that this model
 faces many challenges and there are requirements that must be
met. Dzhafer noted that there should be a database that social
security funds work with, a valuation of medical activities in a
 clearly defined main medical package, and clear medical
standards and rules for good medical practice, as well as that
the amount of the installment that the State pays for certain
groups of citizens should be balanced out.

"We will ask the Finance Ministry and the Health Ministry
whether they would be willing to raise the installments,"
Dzhafer added. In her words, there should also be a guarantee
fund that will guarantee the funds' financial stability, and a
risk pool that will not allow for patient selection.

Bulgarian Socialist Party MP Georgi Mihaylov commented that
there has been no valuation of medical activities and of medical
 experts' labour for many years now. In his words, an
interinstitutional expert group that includes politicians should
 be assembled in order to draw up a national model. "Whether the
 State should increase the health installment it pays is a
question of economic and political assessment," Mihaylov noted.

Bulgarian Ombudsman Maya Manolova noted that the health
insurance model should provide for citizens' needs, as well as
for the demands and needs of medical experts. In her words, the
main questions that need to be answered are the valuation of
activities and the content of the main medical package. "It is
still unclear how demonopolizing the NHIF will solve the problem
 with regional disproportions, or how it will improve patients'
access to modern medicine," Manolova added. RY/DT,TH