site.bta National Health Insurance Fund Budget for 2015 Gets Parliament's Approval in Principle

National Health Insurance Fund Budget for 2015 Gets Parliament's Approval in Principle

Sofia, December 9 (BTA) -  Parliament adopted in principle the
2015 National Health Insurance Fund (NHIF) Budget Bill. It was
supported by 121 deputies while 66 voted against. There were no
abstentions. Health Minister Peter Moskov said that the NHIF
budget will ensure sustainability and will not generate a
deficit for the first time in many years.

The opposition - the Socialists and the Movement for Rights and
Freedoms (MRF) - took a firm stand against the NHIF budget bill
arguing that it does not provide for reforms and has more money
for hospital services than for primary medical care and
prevention. The majority, including GERB, the Reformist Bloc,
the Patriotic Front and ABV, supported the budget but made
various recommendations. The nationalist Ataka "took the budget
as what the neo-Liberal system allows".  

Revenues (including transfers) in the 2015 NHIF budget are
projected at 3,075,534,000 leva, and expenditures (also
including transfers) are exactly the same amount. The medical
insurance is 8 per cent of which 60 per cent is payable by the
employer and the rest by the insured person. The outlays for
primary and specialized out-patient care are increased from
2014, as is the funding for hospital services. The NHIF will
have a reserve of 301,898,000 leva which will be formed by
setting aside 10 per cent of the health insurance contributions
and transfers.

Health Minister Moskov said, as he presented the NHIF Budget
Bill, that it has measures to ensure financial stability and
predictability in the system.

By Friday, the Health Ministry will publish on its website a
package of emergency reforms and before the year's end the
government will move to Parliament a concept paper for
comprehensive reforms in health care, said the Minister.

A workgroup has been formed with the ambition to prepare an
annex to the national framework agreement between medical
service providers and the NHIF as a result of which some of the
activities covered by medical insurance will be removed from the
 hospital sector to the pre-hospital sector, said the Minister.

He also said that the budget bill minimizes the opportunities
for opening new health care establishments which will be
financed by the NHIF, and  broadens the scope of activities of
existing establishments funded by the NHIF. The transitional and
 final provisions in the budget bill say that hospitals which
obtain a permit after December 31, 2014, and those which broaden
 the scope of their activities as of the same date will be
unable to sign contracts or update their existing contracts with
 the NHIF.

"This starts the discussion about what to do to improve the
quality of the existing network of hospitals," said Moskov.

Another proposal by his Ministry is that new pharmacies be
allowed to open only where the existing pharmacies are not
enough or there is no 24/7 pharmacy. 

Moskov said that the Ministry has reached an advanced stage in a
 procedure towards signing a framework agreement with the
pharmaceutical industry for sustainable development and
financial stability. 
   
The Health Ministry has the ambition to set in place an
electronic medicines exchange for hospitals by March 2015 and
Moskov said that he would seek Parliament's support for
legislation to allow this.

NHIF Director Roumyana Todorova said that the budget bill has
252 million leva more than the initial plan but some 150 million
 leva less than the actual expenditures in 2014. "I have big
hopes about the measures that Minister Moskov mentioned because
they are the only way to narrow the gap," she commented.

Hassan Ademov of MRF set out in detail the opposition's
arguments "against", among the key ones being the lack of
priority medical goals, such as life expectancy and infant
mortality, supported by financial resources. "It only offers
fiscal measures," he said.

MRF believe that the planned increase of revenue from health
insurance by 150 million leva will put an extra burden on
employers, employees and self-insured - which is where the money
 will come from. The State (which pays the health insurance for
children, pensioners, unemployed, the military, police and some
other categories) is left with the modest contribution of some 3
 million leva. MRF argued that this violated the Constitution
which provides for shared responsibility. 

"When the health insurance was 6 per cent, the system generated
a surplus. Now it is 8 per cent and it generates a deficit every
 year. It means that the problem is in the rules, the
accessibility and the measures," said Ademov.

MRF is also unhappy to see more funding for hospital services
than for prevention, in a 1:3 ratio.
     
Ademov noted that it is a bad idea to send NHIF controllers to
assess the quality of services provided by hospitals "because
the administration is not in a position to control the medical
community - it has to control itself".

Health Minister Moskov explained that the planned increase of
revenue from health insurance will be no burden for employers or
 employees because the aim is to broaden the scope of people
paying health insurance. He said that the legislators and the
National Revenue Agency will have a role to play here as well. 
 

Emil Raynov of the Bulgarian Socialist Party said it is "a
budget of the status quo" but he nonetheless congratulated the
Minister for not raising the medical insurance and preserving
hospitals in remote areas "which GERB wouldn't normally do".

Health Minister Moskov is a representative of the minor partner
in the government coalition, the Reformist Bloc.
   
Raynov also said that one of the worst problems the system has
to deal with is territorial imbalances and recalled that
Bulgaria has been criticized by the European Commission for lack
 of reforms in the sector.

Raynov said that hospitals' current debts stand at some 470
million leva and warned the Minister that he might end up being
"a general without an army".
 
Valentin Pavlov of the Reformist Bloc said that his group would
support the proposed budget. He said though that it is
imperative to increase funding for dental care for patients aged
 over 18 "because the statistics there is a disaster: an average
 of 17 teeth extracted among patients over the age of 60".

Semir Abu Melih (GERB) asked to know how long the restrictions
on new hospitals will apply and urged the Minister to say what
future he sees for private, state-owned, municipal and
private-public hospitals.

Soultanka Petrova of the Patriotic Front called for regulating
the number of health care establishments financed by the NHIF,
fast introduction of an electronic health card, an integrated
information system and a register of medical practitioners
working with the NHIF.

Georgi Kyuchoukov of ABV said that his group will support the
budget bill "because a bad bill is better than no bill".

Ataka said that for ten years now Parliament has been debating
the same budget, "one restriction after the other". "The reason
is that Bulgaria has no functioning economy and is in constant
stagnation," said Stanislav Stanilov. 

In an opinion about the draft budget for 2015 and the budget of
NHIF, the Federation of Trade Unions in Healthcare calls for
freezing the retirement age in 2015, increasing the minimum wage
 to 400 leva and also increasing the pay in the healthcare
sector of no less than ten per cent in 2015.

The trade union notes that NHIF's draft budget includes - for
the first time in many years, revenue and expenditure that
actually match the performance from the previous year. However,
the trade union warns that a shortage of referrals will be felt
again, which will make people opt for getting admitted in a
hospital for the performance of medical and diagnostic
activities which could otherwise be done in out-of-hospital
care.