site.btaPsychiatric Hospital Budgeting Does Not Allow for Innovation and Quality – Minister

Caretaker Minister of Health Michail Okoliyski believes that historical budgeting is not the right way to fund psychiatric hospitals. Historical budgeting is a method of financing in which the funds for the current year are determined on the basis of expenditure from previous years rather than on real activity, patients treated, or quality of service. "This does not allow for innovation, quality, or development," Okoliyski said at a roundtable in Lovech, which discussed interinstitutional cooperation in support of people with mental disorders at the local level.

The minister added that the State Psychiatric Hospital in Lovech is an excellent example of good practice with its child and adolescent ward, where "doctors with heart" work with the children who need care. The good conditions in the ward were not created with EU funding but through donations from the Lovech community, "and this fills me with pride that I am Bulgarian, that I have fellow citizens who give up part of what they have to support the care of children," Okoliyski said. 

Generally, however, donations are not a very reliable source, he noted. "This must be a systemic commitment of the state, of the Health Ministry, and also of the National Health Insurance Fund," Okoliyski said. According to the minister, National Health Insurance Fund Supervisory Board Director Stanimir Mihailov is fully convinced that there must be clinical pathways in psychiatry that would allow for a mixed model of financing.

Okoliyski went on to comment: "In Bulgaria things usually happen the hard way, so we will apparently walk the entire long road the hard way to reach some universal human truths, namely human treatment for people with disabilities, with mental illnesses, with any need for warm care. Some of these measures would already have been a fact had the proposal to amend Chapter 5 of the Health Act been adopted – a proposal we made two years ago when I was deputy minister and Prof. Hinkov was minister. A working group was formed, including judges and the Bulgarian Psychiatric Association. There was consensus that all those steps to safeguard the rights of people with mental illnesses were urgent."

He also said that there are still individuals with an outdated way of thinking, with a mentality that does not recognize that people with mental illnesses have rights that must be respected, and that they must have access to everything available to those who are not in psychiatric institutions.

According to Okoliyski, a working group is writing a Psychotherapy Bill aimed at making psychotherapy services covered by health insurance, since at present they are paid out of pocket. He expressed hope that the work would be continued by the next government.