site.btaNewly Passed Amendments Introduce Second Deputy Governor of Health Insurance Fund

The National Health Insurance Fund (NHIF) will have two deputy governors, the National Assembly decided by adopting conclusively amendments to the Health Insurance Act. The revisions were passed en bloc with 116 votes in favour, 52 against and 25 abstentions.

The bill was sponsored by Dragomir Stoynev and a group of MPs from BSP - United Left. Socialist MP Ivan Ibrishimov said that the introduction of a second deputy governor aims to improve the efficiency and stability in the management of the NHIF. With the presented changes, a more sustainable and flexible management structure will be achieved by dividing the responsibility between the two deputy governors. This will ensure better control, the MP argued.

According to the adopted texts, the NHIF Governor determines the powers and portfolios of the two deputy governors. It is envisaged that within three months of the entry into force of these amendments, the National Assembly will elect a second  deputy governor  with a term in office until the expiry of the term of the incumbent NHIF Deputy Governor. The provisions also provide that, until the powers and portfolios are defined, the incumbent NHIF Deputy Governor shall continue to exercise their powers in the current manner.

A controversy arose in the plenary hall over the provision stipulating that the NHIF shall pay for the medical care of medical care contractors "within the limits of the amounts set in the contracts referred to in (1) and in accordance with the earmarked funds in the NHIF Budget Act for the relevant year, taking into account the share of the reserve in the event of a decision of the NHIF Supervisory Board under Article 15 (1)." The proposal was made by Valeri Lachovski MP of GERB-UDF. The votes against its adoption came from Vazrazhdane, Continue the Change - Democratic Bulgaria, and Alliance for Rights and Freedoms.

Margarita Mahaeva of Vazrazhdane argued that GERB-UDF's proposal aims to include in the contracts between the Regional Health Insurance Fund and the contractors of medical care the values that are determined by the NHIF budget and the Exchequer to pay only those amounts that are defined in the contract. Mahayeva questioned who will pay for the hospitals' over-limit activities and whether the hospitals will start returning patients again due to excessive indebtedness. She recalled a Constitutional Court decision of 2024 that abolished spending limits.

Vassil Pandov MP of Continue the Change - Democratic Bulgaria (CC-DB) said that GERB-UDF's proposal practically restores spending limits on medical care, making a significant change in the functioning of the healthcare system without an impact assessment and analysis and being passed in a vulnerable way. MP Alexander Simidchiev of CC-DB noted that this year's deficit of the NHIF is estimated at BGN 270 million, compared to BGN 146 million in 2024 that is yet to be covered. Together, that adds up to BGN 416 million, which exceeds the NHIF's entire reserve of BGN 276 million. Hospitals have the option to exceed the limits, but since the Constitutional Court annulled those legislative changes, the excessive spending will have to be covered. "We are practically transferring the financial burden to next year," Simidchiev argued.  

Hasan Ademov MP of Alliance for Rights and Freedoms said that a second deputy governor can in no way solve the issue with the NHIF's deficit of BGN 242 million for medical activities. Spending has to be rationalized by adopting a pricing methodology for clinical pathways and medical professionals' work, he said.

Kostadin Angelov MP of GERB-UDF stated that every Bulgarian citizen in need of medical treatment will receive it. Not a single one will be denied care by a healthcare establishment, he said.