There Is No Better Political Moment For The Proceeding
Dr Vitkova, health care issues are always on the table, but they have been quite a discussion these days in view of the debates over the new health care strategy. There wer even talks about
political war.
Yes, that is true. The strategy was not worked on within the coalition, but in the ministry or elsewhere. A year ago the strategy was sanctioned by the Supreme Council of BSP, but the opinion was
not taken into consideration by the other two political parties of the coalition and that is why everything is at its start again. It is obvious that debates will get real ardent when the startegy
is to be carried.
The idea of a second health care insatlment, the monopoly of the state, privatisation of clinics, the place of the health insurance funds are all bones of contention.
I myself
am not acquainted with the stand of every of the political parties, excluding the fact that DPS did state its clearly. Their idea changed from the idea of total decentralisation of the health care
system to an option of the health care instalment be increased under the form of completing set of medical services provided by the health insurance funds. BSP had its own changes of mind - at one
time the party standed for no changes in the health care model: no instalment increase, no change in the main set of medical services and the health insurance funds to give more money. Now, their
last position makes no clear suggests except the proposal for the development of obligatory develoment of the second pillar in the health insurance system and the other proposal that the health
insurance company should cover for the medical exopenses not included in the main set of services.
You are saying that we are moving towrds a 3-pillar health care system similar to the pension system?
A complete analogy should not be made. If there is a paralel between the two it is in the way the acumulated resources are managed. If there is an obligatory amount (no mater which system we are
taking about) deposited every month and these resources have to be managed the client has to pay administartive fee and certain percentage of the investments profit. Meaning that instead of storing
the money in a payments account, clients can deposit every 1-2 months and benefit on the interst rate. The companies can be stimulated to manage the resources if they are given 0.5% of the
investments profit. But the resources accumulated in the health care system are not the resources accumulated in the old age provision system which will be avalable for the next 20 years, these
resources are available few months only. That is why the single analogy is the resources management. If we would still like to look for analogies we should take into consideration the other health
care systems known in Europe which are different, there is a completing set of medical services in Denmark, in Germany the employees in the public field receive health insurance as a bonus, in
France the state insurance pays in view of the professional burden and the funds make a discount as one additional instalment made by the employer not the employee.
There is by far no model that was found interesting in Bulgaria. The present model is "the book says we can do anything, but we can actually do nothing". No one dares to make any changes in the
main set of medical services, but on the other side the GP is the one that gives his clients the acces to all of the medical services, i.e. the clients' rights are the GP's decision. And it turns
out we are still living in an unreal situation - our set of services is quite a range.
Do you expect the elections to put an end to all of this surreptitiousness or not?
I cannot know for how long all of this will keep on happening, but you gave quite an accurate definition for the present political situation. I think it would be more politically correct to just
say what can be done with the money at hand. And as a community we should decide who gives how much and we all receive medical care or we say the ill pay additionally. It is all a choice of ours.
And this silncing of the problem cannot go on for much longer. The saddest thing is that again a foreigner should tell us that our system is not working properly. I think the time would come soon
and it is inevitable.
What is the suggestion of the Private Health Insurance Fund Association in regard with the second health care insatlment and its amount?
We think that the health care instalment has to be raised, it is more than obvious and it is ridiculous that some say Bulgarian make the lowest instalments in Europe (as percentage from their
incomes and as actual amount per-capita) we can provide health care as well as the developed countries do. It is realy ridiculous. That is why we think the health care instalment should be
raised. The next question is how should the increased amount be managed.
How much do you think the instalment has to be raised?
That is a political decision and it should be made fully aware of the taxation burden for the employers and the employees. I think now is the political moment for this raise and there will not be
another suitable moment soon. Why? Because the social security instalments are reduced by 3% - the employers welcomed the act; the flat tax was introduced. And now is the time for open debate, we
have to confess that our health care system lacks resources and we have to make the political decision how much higher the health care instalment should be. There is no way we can raise it and it
reaches the colossal amount as in the other European countries, but we have to make the first step. I think that the raise should add 2-3% over the present 6%. But it is difficult for me to give
you exact figures. I am worried that no one is paying attention how much money enters the health care system in cash. The State Health Care Institute grant some resources as public and their amount
is known. But when a patient goes straight to a specialist they pay and somebody has to know how much. If all these payments were reported we would have known that we spent not 3-4% GDP, but much
more. And then would my comment for an 8% or 9% instalment have been different. If it turns out that including these payments the amount spent on health care comes to 5% GDP it will mean that the
resources are enough and the problem is in the management. But since there are no such records I base my statement on official reports only. I will not even start talking about all those bribes
sinking in the doctors' pockets which exterior research have calculated to approximately come to the amount of the public budget, i.e. BGN 1 billion. Let's not talk about these resources which are
not invested in the development of the health care system, but it would be good if all the other sums were known.
What is the Association's idea about the health care resources management?
Firstly we do not find the decentralisation of the system that scary. We think that the Sate Institute will be working better under the conditions of competition and the people we have options. The
practice in Europe and the world is different. In Germany and the Netherlands, for instance, which practically wrote the history of health insurance, the social security system takes care of the
people who receive wages to a certain amount. In Germany the people who get higher wages than that certain amount have to make instalments in a private fund as the social security system is not
responsible for their provision. In the Netherlands these people can keep making their payments either in the social security system or in a private company.
In Bulgaria some of the people who get higher wages can make their payments in the private field, too, and the resources can be collected by the State Social Security (as it is now) and then
will the resources be distributed among the private companies the clients have chosen. The argument against this suggestion was the private company will go bankrupt. According to me a fund gone
bankrupt is no worse that the State Institute gone bankrupt when the clinics will be the most affected. The State Institute cannot go bankrupt and it can cut on the prices of the medical services
in the middle of the year, something the private funds cannot afford.
Demonopolisation of the state is one of the options, the other one is the proposal of the completing set of medical services and these resources be available for the private funds to manage. Why is
this suggestion reasonable? There will be more participants on the market, the clinics will get interested in the private companies and the clients will get, too. The citizens will as well acquire
a different insurance literacy and the clinics will be aware of the fact that the patient has to receive the best as they will be presided over professionally and financially. That is why I do not
find any opposition to this suggestion justified.
Are there any other grave issues impeding the health care system?
No political concord can be achieved. Some say that until everything is privatised there will always be problems. The health care system is not managed well and we are trying to solve the problem
by changing ownership. I do not think that there is another place such nonsense is allowed and performed. No European state has entirely transfered all of the health care responsibility to the
private companies. The public and the private fields are partnering to each other. The private companies are always after the profit and they stimulate the public sector to work at the same pace.
In Bulgaria we go from one extremity to the other and the Ministry of Finance says "no money will be invested in something incomplete". We cannot close hospitals since we are slightly below
the average European levels when it comes to number of beds in the clinics per-capita.
Notwithstanding all the confusion, however, new health insurance companies emerge, the business expects great growth. The interest towards health insurance is recent since the talks about the second health insurance instalment were initiated.
What are your expectations once the Health Care Strategy is carried?
Once the Strategy is carried nothing will happen in 2008 as the budget is already prepared. Eventually some legislative amendments can be introduced. I will once more say that now is the time for
changes,no mater that it is pre-elections time, too. I think that the opposition will support the augmentation of the health care instalment, the partial decentralisation of the system and the
greater responsibilities of the private funds. The more resources to manage means more strict requirement, of course, obligatory capital augmentation and better business. That is why those who are
to establish a health insurance fund no fast money will come.
Dr Mimi Vitkova is the chairperson of the Association of the Licensed Supplementary Health Insurance Companies and the CEO for Doverie AD.
Extracts from the National Health Care Strategy (2008-2013)published on the web page of the Ministry of Health Care:
Strategy Objective VIII
Financial Stability of the State Health Care System
...
2.Obligatory Health Insurance Development:
- Augmentation of the health insurance instalment with no increase of the taxation burden.
- Legislative amendments introducing supplementary health insurance done by the private health insurance companies meeting the respective business requirements.
...
4. Supplementary Health Insurance Development:
- Improving the health insurance literacy of the population
- Supplementary Health Insurance companies cover for the medical services the State Institute is not paying for - urgent non-hospital care provision; dental care; covering pharmaceutical expenses;
patients fees;
- Supplementary health insurance is to gradually invest more and more in the health care system.
- Taxation relief introduction for physical and juridical persons.
- Legislative amendments fighting unlicensed medical services provision.
Expected Results:
- The private sector is to get more involved in the health care system.
- The health care system is to be financed better.
- Higher quality of medical service and satisfaction to all parties involved.
