Professor Radoslav Gaidarski showed firmly that he is not the minister to reform the health sector in such a way as to make it efficient and useful for the patients.
It also became clear the upcoming fourth discussion of the health strategy project may lead to a serious conflict within the ruling three-party coalition. Thier individual positions remain polarised. Thus, the Movement for Rights and Freedoms and the National Movement Simeon the Second (NMSS) insist on demonopolising the sector and creating competition by introducing secondary health insurance. For a short while the Bulgarian Socialist Party (BSP) seemed to agree. This week, however, Gaidarski eliminated all hopes of the patients to choose where to pay their insurance and where to be treated, by saying there will be no demonopolisation at this stage.
Like a movie
According to unnamed source from BSP, the main reason for the party to oppose its partners on the health issue is...a movie, Michael Moore's Sicko. Strongly impressed by the dramatic events in the film the party's leadership decided to put their stake on a propaganda campaign stating that giving more rights to private health funds means undermining the citizens' constitutional right of equal access to medical care. "The state must guarantee each person's health. We can't just leave people to die," said an unnamed member of Parliament.
According to Gaidarski, it will be a positive development if private health funds take a more active part in health insurance, but it seems he is not willing to let them generate profits. This was his main argument for condemning the idea of private health insurance on an equal basis with the state National Health Insurance Fund (NHIF). 'Currently, NHIF allocates a total 3.0 pct for self-support and has no right to profit. We can't let private funds profit if this insurance is obligatory for all citizens,' says the Minister. He believes if private funds receive insurance installments they also should allocate 3.0 pct for self-support and be denied the right to own hospitals.
The Minister's idea of demonopolisation is the following: the state will increase the health insurance installments for the citizens and/or the portion of money from GDP allocated for health services, and the private funds will only receive the margin between the old and the new increased allocations. Thus they will not be in actual competition with the NHIF.
According to Dr. Mimi Vitkova, chairwoman of the Association of Private Health Funds, such ideas are counterproductive for the market. "If a private health fund has good management and invests its clients' money profitably and to their advantage it should have the right to 1.0 pct or 2.0 pct of this profit, similar to the pension insurance funds,' Vitkova says. It is not a practice for private health funds to own hospitals, but even if any one of them decides to build and operate such a facility it will be easy to control the clients' funds management, by simply imposing a ceiling on prices for health services.
Take one, take two...
'The idea is there should be alternative services and anyone would choose what to pay for. This, however, involves a political decision to explain to the public that health services are not and cannot be equal for everybody. Until politicians stop insisting that health services are free the hospitals will continue to appropriate funds from the NHIF and take bribes from patients,' according to Lachezar Bogdanov, executive partner in industry Watch-Bulgaria.
How private funds profit
The earnings of private health funds total 14 mln levs for the first half of 2007, while payments for medical sevices stand at 7.0 mln levs. The private funds are controlled by the Financial Supervision Commission (FSC), which licenses their prices and approves the size of insurance payments for each medical service package. A large part of the accumulated money is used for guarantees for participation and good paractice in tenders under the Public Procurement Law for the selection of a health fund. Private health funds also have the right to invest unlimitedly in treasury bonds and deposits. In case they acquire over 10 pct of the shares of any company they would need the approval of FSC which will also assess how the deal will influence the fund's financial stability.
The model that economists and private fund representatives put forward as most realistic and efficient is to reduce the service package for which we all pay to life-saving procedures and general check-ups. A second health insurance will be paid for a selection of health services chosen by the individual patient. This insurance will cover all selected procedures. To be able to implement such a model the funds will have to design the widest possible range of packages, from the cheapest to the most expensive, and to sign cooperation contracts with hospitals. The state must be as distanced as possible from this process. 'Otherwise, there is no sense in having five health funds with identical service packages,' says Lachezar Bogdanov.
'There are no signs that the ruling coalition has the will to demonopolise the system,' says Dr. Vitkova. 'There has been no discussion on a second insurance, who will pay for it - employees, employers, or the state - in what ratio, and what will be its size. Nothing is clear and the Government is preparing to discuss the budget for the NHIF soon.' This means that no actual action can be taken earlier than 2008.
$ = 1.4406 Bulgarian levs
1-5/09/07, p.14-15
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