site.btaConstitutional Court Upholds Constitutionality of Legal Provisions on Medics' Salaries

Bulgaria's Constitutional Court on Wednesday adopted a decision upholding the constitutionality of two provisions of the Health Insurance Act concerning medics' salaries. The vote was 10 in favour, one dissenting opinion by Judge Sonya Yankulova, and an opinion by Judge Sasho Penov, the Court said in a press release.

The case was instituted on a petition by the Supreme Administrative Court (SAC) for declaring the unconstitutionality of two litterae in Article 55 (2) of the Health Insurance Act.

Acting on an appeal by the National Association of Private Hospitals against the latest national framework contract, SAC argued that the provisions in question breach the principles of free economic enterprise and of the State committed to the rule of law because they do not introduce clear criteria for the allocation of the extra funding for medics' salaries in outlying areas, whereas the pay criteria for priority hospitals can be changed at any time. 

According to the first provision, the national framework contracts concluded between the Bulgarian Medical Association and the National Health Insurance Fund (NHIF) must contain requirements regarding the basic labour remunerations of medical specialists working at hospitals in performance of contracts with the NHIF, which are not less favourable than those envisaged in a collective agreement in the healthcare sector.

The Constitutional Court found that this provision aims to provide hospitals with medical specialists by furnishing legal guarantees of fixed minimum amounts of their labour remunerations. In the opinion of the court, the provision of accessible and high-quality medical care depends on the availability of qualified medical specialists which, in turn, requires a fair and decent pay of their work. The Court further noted that ensuring a set minimum amount of such remuneration is equally binding on all hospitals which receive financing from the NHOF budget and does not encroach on their level playing field.

According to the second provision, the national framework contracts must contain a methodology for financing the recruitment of medical personal at medical-treatment facilities performing medical activities in nucleated settlements in inaccessible and/or outlying areas or which are the only one implementing the activity concerned in the territory of the municipality ("priority hospitals").

The Constitutional Court held that this provision seeks to protect citizens' right to accessible medical care, which is internationally recognized and constitutionally guaranteed. The Court argues that free economic enterprise cannot ensure citizens the right to health but does not release the State from the obligation to guarantee this right, which is precisely why the State may and is constitutionally obliged to take measures guaranteeing all its citizens accessible medical care when the free market and competition are unable to secure this.