News and Media

The participants in the National Round Table on Reforms and Healthcare without Restrictions insist that the government restores the principle “the funding follows the patient”

“We do not accept and will not accept in the future the activities of the medical institutions to limit and thereby to put bounds on the rights of patients to have access to timely and quality treatment.” So begins the declaration which has been signed by the Center for the Protection of the Rights in Healthcare, the Federation Bulgarian Patients’ Forum and the Bulgarian Association for Patient Rights, the National Association of Private Hospitals, the Association of Municipal Hospitals, and the directors of more than 30 hospitals. The participants were against the norms that lead to the administrative closing down of hospitals, the forced mergers, and the imposing of administrative limitations on the construction of new hospitals. According to them, the success or failure of a hospital should depend entirely on whether the patients are satisfied or not by the treatment provided.

“We insist that the government restores the principle “the funding follows the patient ” and creates the necessary rules for the effective and objective control by the institutions, as well as by the consumers of medical services, over the quality of medical activity,” states the declaration.

According to a reference of the Health Fund,  provided to the Medical Association, from March to July the hospitals have exceeded their limits for BGN 31.8 million, which at the end of the year is expected to reach BGN 60-65 million. In a letter to the NHIF the chairman of the BMA Dr. Ventsislav Grozev points out that the healthcare providers are becoming “unpaid donors of the healthcare system.” The Professional Association recalls the legal precedents so far which show that ultimately the NHIF will have to pay the hospitals for the performed activities together with the accrued interest.

Stoycho Katsarov from the Center for the Protection of the Rights in Healthcare stated that all agree that currently the system is not good and needs to change, but he is skeptical whether the reforms undertaken would lead to the desired effect. “The healthcare system would be at its best when it is viewed as a market that offers business services, and not as an administration,”  he noted.

The National Association of Private Hospitals commented that the limitations achieve the opposite of what the government claims, namely that the reform works in favor of a higher quality and comprehensive treatment. “The patient goes to the hospital, where he is told he cannot be admitted because of the restrictions. He returnes home and waites to be admitted by this particular doctor at this hospital which he has chosen while his illness is getting worse and his treatment is becoming more expensive. Doctors are beginning to lose confidence in the system and motivation. What this reform achieves is a more expensive treatment, not better quality. ”

Patients’ representatives stressed that the populist statements of politicians that the restrictive policies are in the interest of patients, are not true. “When you undertake reforms in healthcare, it is useful to hear the voice of both – the patient and the professional organizations.”

“If someone steals through clinical pathways, this should be controlled and determined by the NHIF,” said the chairman of the Association for the Protection of Patients and noted that the vicious circle of generating activity that exceeds the limit is due to the planned budget deficit of the NHIF in the recent years .

“We need an urgent discussion on the subject matter of the healthcare budget for 2016,” said the representative of the Supervisory Board of the NHIF Grigor Dimitrov. As an employer,  the representative of the Confederation of Employers and Industrialists in Bulgaria in the Supervisory Board was adamant that the limitations are not the way to manage any kind of activity.

The Roundtable participants agreed on the idea that the state should take care to increase the collection of the health insurance contributions, as well as the payment of the full amount. They insisted on increasing the percentage of the GDP for healthcare, which is separated from the budget. The guild accepts the stated intention of the government to provide comprehensive treatment in full, observes that it is available not only through the impoverishment of the structures, but also through organizational and financial mechanisms.

The specialized hospitals of the Bulgarian Cardiac Institute in Varna, Veliko Tarnovo, Shumen and Yambol mark the World Heart Day with an appeal for prevention and free consultations

Every year on the 29th of September  the world celebrates the International Heart Day. In connection with this the experts reminded us that according to the “black statistics” every third death in our country is a result of cardiovascular disease, although 80% of the cardiac problems are preventable if detected on time.

“Atherosclerosis and cardiovascular disease are considered to be the largest non-infectious epidemic diseases of our time, in a word – they are the biggest killer of the 21st century,” said the national consultant in Cardiology Assoc. Prof. Ivo Petrov, MD.

“The high level of lipids in the blood is a major risk factor in the early development of cardiovascular disease. The lipids that circulate in our blood come mainly from two sources. One depends on how a person eats and the second, which is even more dangerous, is genetically determined – these are the lipids that our own organism has synthesized. A lot of people have this kind of family history, but it may be less or more risky, depending on the case. In such people the developing of cardiovascular diseases is not potential, it is the rule.

In order to determine whether we are genetically endangered or not it suffices that we know the history of the disease and the cause of the fatal end in our parents or their parents. We, cardiologists, constantly insist on mass screening which should follow simple clinical criteria and laboratory tests. The verification through the lipid profile is widely available throughout the country. But any changes in the electrocardiogram and the echocardiogram should be monitored as well, which, however, are carried out during the second stage. And mainly in people who have cases of early signs of atherosclerosis in their family – either a stroke or myocardial infarction. This is the target group of the Bulgarians who definitely have to be tested, in order to determine if they have a hereditary predisposition to these diseases or not. ”

This year the hospitals of the Bulgarian Cardiac Institute – the Specialized Hospital for Active Treatment in Cardiology in Varna, the Specialized Hospital for Active Treatment in Cardiology in Veliko Turnovo, the Specialized Hospital for Active Treatment in Cardiology in Yambol, and the Specialized Hospital for Active Treatment in Cardiology in Madara – Shumen are joining together in the celebration of the World Heart Day by offering free examinations, taking blood pressure and providing individual consultations.

For the first time clinical trials will be conducted to check if a drug prolonged life, said magazine  Sciences et Avenir. The medicine in question is metformin, which is often administered to patients affected by diabetes type 2. In 2008, the study of Russian scientists showed that it prolonged the lives of mice, probably by restricting the calorie intake and controlling the level of glucose. The published in 2014 results from the statistical survey conducted by scientists from the University of Cardiff, UK, included 180 000 people and showed that the treated with metformin diabetics had higher life expectancy than non-diabetics.

This is why, the expert Nir Barzilai at the Albert Einstein College of Medicine in New York launched the TAME / Targeting Aging with Metformin /project. It will monitor the health of 3 000 non-diabetics aged over 70, some of which will be taking metformin for five years, while the other participants will be included in the control group.

Other anti-aging drug – rapamycin, is also being tested. It suppresses the immune response and is often prescribed during transplants. It has been tested on mice and prolongs their lives. Currently, the scientists from the University of Washington in Seattle tested the drug on dogs. Their hopes are that rapamycin will extend the life of the four-legged animal from 2 to 5 years.

Tchaikapharma High Quality Medicines Inc. offers on the Bulgarian market  Metformin-Tchaikapharma (metformine), indicated for the treatment of type 2 diabetes mellitus.

According to Minister Moskov, when one has a facility in the big city where people have assets, one has to take responsibility for the system as well. According to the guild, the solution is to permit subsidiaries

Administratively forcible is the method imposed by the state that out of the 4 pharmacies, which an owner is entitled to have, one necessarily has to be located in a small village, the second one – to work round the clock and the other two – whatever the owner considers.

This is what was stated by Nikolay Kostov, chairman of the Association of Pharmacies Owners, in connection with the forthcoming reforms in the Drug Law by the Health Minister Dr. Petar Moskov, which would be the next one to be “repaired”. Kostov predicted that if the idea was implemented, the owners would go around it. For example, a natural or legal person would open up to 2 pharmacies in the cities wherever they decide, and this way the requirement for the other two would be avoided.

The Minister launched his proposal in February this year and then he said:” when one opens a pharmacy in the big city where people have assets, and it is effective, one has to take responsibility for the system, even if this is not a market method”.”Even during post-socialist times there was no such regulation! The opening of pharmacies is encouraged in small towns everywhere in the EU, but only where this is possible. In some places it is a lost cause,” said Kostov.

According to research, in order for a pharmacy to exist in the EU, there should be at least 1200 inhabitants, while in some places a pharmacy serves 15 000. Another determining factor is overcharge. The more it is “suppressed”, the more patients are needed in order for the facility to not go bankrupt. “In our case, although higher overcharge is permitted, it is usually 10-13 to 14%. Of course, if it is 30%, then the pharmacy can function even in a village with 800 people,” said Kostov. He added that people from smaller places have a different income and consumption than in cities. And if the village has no doctor, it is absurd to open a pharmacy, because no one can prescribe medication. And if the patient goes to a big city to see a doctor, it is logical he would to buy his drugs there as well.

Kostov recalled that years ago the state and the municipalities were allowed to open pharmacies, but they all were privatized, as they had debts. “So the state abdicated from this type of activity, and now wants to move it over to us”, he added. While the idea may seem social, it was “wild populism” that protects only the interests of the occupational group.  According to the Association of Pharmacies Owners a solution would be to allow the pharmacies in major cities to have branches in small villages which would work 1-2 times a week for several hours, and not only with a master pharmacist, but with an assistant pharmacist as well.

Doctors specializing in Medicine will have a right to a contract with the NHIF was decided by the MPs yesterday, when they accepted the amendments to the Law on Medical Institutions. This way they made the promise of the Health Minister Petar Moskov, which he made to the doctors in the campaign “Young Medic”, become a fact.

Specializing doctors currently do not have the right to work with the Fund and this is the reason why hospitals find it difficult to provide the necessary funds to ensure they have good salaries. However, this will change with the changes and clinics will want to recruit young physicians on staff. Furthermore, the MPs adopted the opportunity for emergency doctors to work more flexible shifts, and in the areas where there are no clinics, physicians are required be on duty at least 10 hours a week.