The 2008 Budget Bill has provided yet another platform for a verbal spat over public sector reforms.
The budget-related altercations over the past week re-echoed public concern that reforms in the education and health care sectors were in dire need of implementation within the so-called second generation of reforms, but little has been done to provide the necessary momentum.
Passions over the teachers strike fading away, now it is health care with actors from all sub-segments speaking on all the malaises plaguing the sector taking centre stage.
The past week witnessed an unprecedented and concerted action from all the professional organisations the Doctors Union in Bulgaria, the Dentists Union and the Pharmaceuticals Union. Debate took all forms that can ensure publicity, from calls for joint debate with the Health Ministry and the National Health Insurance Fund (NHIF) to media statements and news conferences. The pool of doctors voiced their joint concern about insufficient financing. As reported earlier, there is a 50 per cent difference between the alternative budget of the BUD and that of the Government-endorsed Finance Ministry.
Debate went on to tackle the doctors request to strike out doctors in schools and redirect proceeds to other items within the Health Ministry budget. Doctors believe this particular service is redundant and they argue that there would be few volunteers to practice for pay as low as 300 leva a month, as is the allotment of the Health Ministry.
Doctors spoke out against the Health Ministrys request to put a financial cap to each hospital to avert the debt accrual issue that has eaten up budget surpluses in previous years. The medical community insists that such a restriction would infringe on patients inherent right to freely choose the place of treatment.
Further down the health care sectors frown roster is the drugs reimbursement list. Pharmaceutical associations believe that the Health Ministrys decision to revise the rules on medications entry to the NHIF preferential list a month before the year expires is belated. The registration procedure, they argued, is too long to fit within a month. And their second argument saw the Health Ministrys decision to cut the mark-up on drugs by 50 per cent as hurting companies aspirations to align to Europes best practices. While the ministrys goal with this initiative is to terminate the practice of reimbursing expensive medications and use the same proceeds to buy more of the same drugs at a cheaper price, pharmaceuticals insist that sale of drugs at a low margin will trim their investment budget to near zero.
The Health Ministry seems to have regarded the doctors stance as nothing more than the routine debate that accompanies every years Budget.
For the time being, Finance Minister Plamen Oresharski and Health Minister Radoslav Gaidarski are confident in the proper calculations on the health care budget for next year. They reiterated that disparity in positions originated from the lack of ideologically common ground. While the ministrys policymaking attempt is to re-shape an obsolete system, the parties involved are concentrating on the financial sustainability of the existing one. Hence the problems in discourse.
In a November 12 interview with Standart daily, Gaidarski said that the shortcut to solving hospitals financial woes stepped on pruning to optimum a redundant hospital system. Taking his vision further, he said the system should retain as core the university and the 28 regional hospitals and then sell or co-manage the remainder together with local or EU-registered hospital operators. After such sell-offs, future hospital owners would be obliged to retain hospital treatment as core activity, but also would be entitled to develop related activities such as retail through shops on the premises of the hospital. A strategy to this end is due to be put up for approval by the Cabinet and Parliament, he said.
Currently, Bulgarian law bans the sale of hospitals and, therefore, to set the strategy on the go, Gaidarski needs the legislative support of Parliament.
The idea has already been enacted in a number of countries from the 2004 EU enlargement wave. The education sector should follow the same path, with both the number of schools and teachers staff in need of trimming.
With this dissonance in positions and with all the parties to the dispute each confident that they are correct, the figures in the 2008 Budget Bill are unlikely to undergo substantial adjustments.
