Due to the Health Fund budget, a sharp reaction came from the Bulgarian Medical Union, which is on alert for a protest. Last week, doctors declared themselves against a planned new mechanism for determining the prices of clinical pathways in the event of overspending by hospitals. On Wednesday, objections to individual texts in the Health Fund bill came from both the pharmaceutical and dental unions, Nova TV reported.
After the draft budget for the NHIF was published and approved by the Supervisory Board, the text also went to a committee along with the state budget and the plan-account for the DOO. However, this meeting may prove decisive for its revision, as in addition to a position to the media, the Bulgarian Medical Association categorically stated its disagreement with it before four parliamentary committees.
The main reason for the dissatisfaction on the part of the doctors is a text referring to the clinical pathways, which has not appeared in this form in the previous budgets of the health insurance fund. According to it, if the threshold for permissible overspending of activities by medical institutions is exceeded, the prices of the clinical pathways will be reduced. The mechanism stipulates that this should be done first as an agreement between the health insurance fund and the BMA, and if no agreement is reached – by reducing prices, the step for which the NHIF will determine.
„The BLS does not accept the draft budget presented by the NHIF, because there we find strong collisions between the entire contractual process between us and the NHIF", said the chairman of the Bulgarian Medical Association, Dr. Nikolay Brunzalov.
He also added that they have informed all interested parties of their arguments and are expecting their reaction. „There are so many contradictions in this Law. In the "hospital care" part, there will be no contractual process", Brunzalov said. He added that "in this option, it is absolutely unacceptable to remove the contractual principle". "If there is any mechanism by which to control the volumes, it should be agreed upon between the Bulgarian Medical Association and the National Health Insurance Fund, and not inserted into a law in this insidious way", he also said.
If this text is not dropped or changed, the Bulgarian Medical Association is categorical – they will move on to effective protest actions.
„I call on the committee to show understanding. We have given our opinion in extremely detail. "Take into account what doctors in Bulgaria think and not ignore them from the contractual process," Brunzalov also said.
The doctors' statement makes it clear that they define this mechanism as unprecedented.
The full position of the Bulgarian Medical Association, which they expressed to the media before the NHIF budget was submitted for discussion by a committee on Wednesday:
„The Bulgarian Medical Association (BLS) and the organizations of all hospitals in Bulgaria have declared themselves against the proposed mechanism for controlling the macro-framework of the Fund's budget in the NHIF Draft Budget. It provides that, in the event of an established overspending of the Health Insurance Fund budget, in the middle of the year and only in Hospital Care, the prices of all clinical pathways will be reduced.
The unprecedented measure, which is being proposed for the first time and only for the health sector, will make it impossible for medical institutions to work, support themselves, pay salaries to medical staff and treat Bulgarian patients. Moreover: on the one hand, the measure is discriminatory and violates the rights of medical institutions that have good financial discipline, and on the other hand, it cannot fulfill its goal of limiting consumption, because the only thing it proposes is to reduce funds for health service providers.
We are also surprised by the fact that out of all health insurance payments, only hospitals are planned to reduce prices in the middle of the year. In case of exceeding the budgets for medical devices, medicines, dental services, a similar measure is not proposed. The scandalous proposal also contradicts the requirements for the mandatory amount of remuneration for doctors, which are set by the Health Insurance Act, the Bulgarian Health Insurance Association (BHI) states.
According to the organization, the mechanism is nothing more than a convenient way to create a hidden deficit and form the deceptive feeling that there is enough money for Hospital Care, but there are insufficient funds for all other activities.
And against this background, against the background of the obvious shortage of funds in the system, the introduction of a new activity, the so-called biomarker testing, which will also draw funds from the NHIF hospital care budget, is proposed.
The Bulgarian Medical Association and all hospital organizations believe that effective control in the system is necessary and once again we propose that it be carried out with the participation of the patient. Every medical activity requested for payment by the Fund must be verified by the patient, including the dispensing of medicines paid for by the NHIF. Similar systems have been operating in the banking sector for years and it is surprising why their introduction in healthcare is being postponed.
We categorically insist that the mechanism for controlling hospital finances be removed from the Draft Law on the NHIF Budget for 2025. We insist that the Bulgarian Medical Association and the NHIF agree on an adequate mechanism, respecting the contractual principle, otherwise, the Bulgarian Medical Association and the medical institutions will move to effective protest actions, says a position distributed to the media.
The position distributed by the Bulgarian Medical Association was signed by the Association of University Hospitals, the National Association of Regional Multi-profile Hospitals for Active Treatment, the Association of Municipal Hospitals in Bulgaria, the National Association of Private Hospitals and the Bulgarian Hospital Association.”