TWO million Bulgarians might be left out of the system of health services due to failure to pay some of their healthcare contributions from January 2000 to today.
This news caused shock two weeks ago, although it was no surprise to anyone, as the National Health Insurance Fund (NHIF) has been warning of this threat for the past six months. Nevertheless, the reaction to the news showed an alarmingly high figure of people affected as well as an alarmingly low level of people informed about their future fate.
Due to a change of the health system from a tax oriented to an insurance-based system, people in Bulgaria who were not able to pay their insurance in the last four years will have no further access to health care.
General practitioners (GPs), who are supposed to continue treating their patients, will lose at least 40 per cent of their patients and this could lead to bankruptcies among them. The damage will be twofold: to the people who will have no access to health care, and subsequently to GPs who will lose patients.
Most but not all of the people affected are of Roma origin, research by the international organisation Medicines Sans Frontiers (MSF), published in Sofia last week, showed. Roma people encounter more problems accessing health care than other Bulgarians. These barriers are due to poverty, uneven allocation of health facilities and personnel as well as communication problems between Roma and health care personnel, MSF said.
So, Bulgarians found out that those of them who had not paid health insurance contributions regularly, will pay between 1.20 and 10 leva for a medical checkup. GPs in Large Bulgarian cities will charge 10 leva for a checkup. Doctors, who do not want to lose their patients, will keep the price of 1.20 leva. But the biggest shock would be a visit to a specialist in a hospital, where the bill will be much higher.
As expected, especially in times with coming elections, all Bulgarian political forces jumped with determination to draw as much dividends as possible from the problem. The opposition accused the Government of failing to lead a proper health insurance policy. The incumbents accused the National Social Security Institute (NSSI), which collects the health insurance contributions, of failing to take care of the situation on time.
Meanwhile, President Georgi Purvanov entered the scene on October 1, fiercely criticising the legislation that would cut the NHIF funding for people who have not regularly paid their health insurance contributions.
Purvanov said the law was unjust to workers and employees, whose employers have missed to make the due contributions. The legislation is meant to tackle the issue of chronic deficits in the NHIF, to which all employed people must make monthly contributions equal to six per cent on their salary.
However more than two million Bulgarians have not made such payments for at least three months since 2000. Many have not made any contributions at all, causing deficits that the Government is covering with state budget funds.
Under the law, NHIF should stop paying for treatment of irregular contributors. This means that they will have to meet their health care expenses themselves, which is unaffordable for most Bulgarians.
Purvanov said the law should have made a distinction between businessmen and self employed, who have to pay their entire health contributions themselves and workers and employees, who share the payments with their employers.
"It will be illegal if a general practitioner refuses to examine or asks for money a person, whom the state or the employer have not insured for the respective period although they have been supposed to," Purvanov said in a statement.
Experts commented that the problem with the "free of charge" medical services have uncovered one of the heaviest problems of the healthcare system in Bulgaria for the entire transition period. The problem is in the failed reform, which was supposed to tie the health insurance to the access to medical aid.
Two million Bulgarians had to find themselves threatened to fall out of the board of the healthcare system, to demonstrate that it almost does not exist. And although the number of people without medical insurance was known in late 2003, no political will could be harnessed for a radical change without which the system is doomed to collapse.
The political consensus that seems to be emerging from the left and among the incumbents themselves is that shortfall caused by the non-payment of due health insurance contributions will be offset with resources from the budget surplus, an approach that might offer a brief reprieve but will not solve the problem conclusively.
The critics say the ongoing reform of the health system has resulted into two distinct systems for access to medical care: the official one and a second, hidden system where the payment for medical services is neither regulated nor accounted for. Recent data suggest that the safety net of the NHIF has missed not only the poor who cannot afford to buy medical insurance but also the large number of Bulgarians working abroad and those employed in agriculture.
Government may consider an opportunity for remittance of the debts of people, who have failed to pay their health insurance contributions, or for extending the grace period. This was hinted at in statements on October 4 by Prime Minister Simeon Saxe-Coburg and Government spokesman Dimitar Tsonev.
We should always think of the patients first, but not to assume a purely administrative viewpoint, or the stand of a particular guild, Saxe-Coburg said. He promised that the Cabinet would find a consensual solution of the problem as soon as possible.
The matter, for which the President pleads, is part of the Government's programme, Tsonev said, commenting on the appeal by Purvanov to ensure access of every Bulgarian citizen to health services. Tsonev could not say whether there is a project for amendments to the Health Insurance Act, which has already been delivered to the ministries for co-ordination.
However, Government is in a checkmate situation, as whatever measures it devises will serve only as a temporary solution. If it decides on an amnesty to non-paid contributions, this will make many Bulgarians to continue the practice of non-payment. And the Cabinet cannot leave two million Bulgarians without access to the healthcare system. Even a budget injection to the NHIF is not a good starting point.
Meanwhile, the leadership of the Bulgarian Industrial Association (BIA) proposed an interesting model for solving the problem. BIA chairman Bozhidar Danev said that all citizens, regardless of their status have to be allowed to continue using the healthcare services and the necessary money have to be taken from the reserve of the NHIF deposited with Bulgarian National Bank.
Meanwhile, State Receivables Agency has to start collecting the due contributions from the ones who have not paid them, and transferring them to the health insurance fund. The public has to learn that paying the money due to the state is inevitable, Danev said.
This news caused shock two weeks ago, although it was no surprise to anyone, as the National Health Insurance Fund (NHIF) has been warning of this threat for the past six months. Nevertheless, the reaction to the news showed an alarmingly high figure of people affected as well as an alarmingly low level of people informed about their future fate.
Due to a change of the health system from a tax oriented to an insurance-based system, people in Bulgaria who were not able to pay their insurance in the last four years will have no further access to health care.
General practitioners (GPs), who are supposed to continue treating their patients, will lose at least 40 per cent of their patients and this could lead to bankruptcies among them. The damage will be twofold: to the people who will have no access to health care, and subsequently to GPs who will lose patients.
Most but not all of the people affected are of Roma origin, research by the international organisation Medicines Sans Frontiers (MSF), published in Sofia last week, showed. Roma people encounter more problems accessing health care than other Bulgarians. These barriers are due to poverty, uneven allocation of health facilities and personnel as well as communication problems between Roma and health care personnel, MSF said.
So, Bulgarians found out that those of them who had not paid health insurance contributions regularly, will pay between 1.20 and 10 leva for a medical checkup. GPs in Large Bulgarian cities will charge 10 leva for a checkup. Doctors, who do not want to lose their patients, will keep the price of 1.20 leva. But the biggest shock would be a visit to a specialist in a hospital, where the bill will be much higher.
As expected, especially in times with coming elections, all Bulgarian political forces jumped with determination to draw as much dividends as possible from the problem. The opposition accused the Government of failing to lead a proper health insurance policy. The incumbents accused the National Social Security Institute (NSSI), which collects the health insurance contributions, of failing to take care of the situation on time.
Meanwhile, President Georgi Purvanov entered the scene on October 1, fiercely criticising the legislation that would cut the NHIF funding for people who have not regularly paid their health insurance contributions.
Purvanov said the law was unjust to workers and employees, whose employers have missed to make the due contributions. The legislation is meant to tackle the issue of chronic deficits in the NHIF, to which all employed people must make monthly contributions equal to six per cent on their salary.
However more than two million Bulgarians have not made such payments for at least three months since 2000. Many have not made any contributions at all, causing deficits that the Government is covering with state budget funds.
Under the law, NHIF should stop paying for treatment of irregular contributors. This means that they will have to meet their health care expenses themselves, which is unaffordable for most Bulgarians.
Purvanov said the law should have made a distinction between businessmen and self employed, who have to pay their entire health contributions themselves and workers and employees, who share the payments with their employers.
"It will be illegal if a general practitioner refuses to examine or asks for money a person, whom the state or the employer have not insured for the respective period although they have been supposed to," Purvanov said in a statement.
Experts commented that the problem with the "free of charge" medical services have uncovered one of the heaviest problems of the healthcare system in Bulgaria for the entire transition period. The problem is in the failed reform, which was supposed to tie the health insurance to the access to medical aid.
Two million Bulgarians had to find themselves threatened to fall out of the board of the healthcare system, to demonstrate that it almost does not exist. And although the number of people without medical insurance was known in late 2003, no political will could be harnessed for a radical change without which the system is doomed to collapse.
The political consensus that seems to be emerging from the left and among the incumbents themselves is that shortfall caused by the non-payment of due health insurance contributions will be offset with resources from the budget surplus, an approach that might offer a brief reprieve but will not solve the problem conclusively.
The critics say the ongoing reform of the health system has resulted into two distinct systems for access to medical care: the official one and a second, hidden system where the payment for medical services is neither regulated nor accounted for. Recent data suggest that the safety net of the NHIF has missed not only the poor who cannot afford to buy medical insurance but also the large number of Bulgarians working abroad and those employed in agriculture.
Government may consider an opportunity for remittance of the debts of people, who have failed to pay their health insurance contributions, or for extending the grace period. This was hinted at in statements on October 4 by Prime Minister Simeon Saxe-Coburg and Government spokesman Dimitar Tsonev.
We should always think of the patients first, but not to assume a purely administrative viewpoint, or the stand of a particular guild, Saxe-Coburg said. He promised that the Cabinet would find a consensual solution of the problem as soon as possible.
The matter, for which the President pleads, is part of the Government's programme, Tsonev said, commenting on the appeal by Purvanov to ensure access of every Bulgarian citizen to health services. Tsonev could not say whether there is a project for amendments to the Health Insurance Act, which has already been delivered to the ministries for co-ordination.
However, Government is in a checkmate situation, as whatever measures it devises will serve only as a temporary solution. If it decides on an amnesty to non-paid contributions, this will make many Bulgarians to continue the practice of non-payment. And the Cabinet cannot leave two million Bulgarians without access to the healthcare system. Even a budget injection to the NHIF is not a good starting point.
Meanwhile, the leadership of the Bulgarian Industrial Association (BIA) proposed an interesting model for solving the problem. BIA chairman Bozhidar Danev said that all citizens, regardless of their status have to be allowed to continue using the healthcare services and the necessary money have to be taken from the reserve of the NHIF deposited with Bulgarian National Bank.
Meanwhile, State Receivables Agency has to start collecting the due contributions from the ones who have not paid them, and transferring them to the health insurance fund. The public has to learn that paying the money due to the state is inevitable, Danev said.
