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Starting today till the end of December the medically insured citizens can change their GP, if they wish to.

It is not necessary for the people who have chosen a new family doctor to notify the former one, this happens through official channels. For the change a patient has to have a registration form for the permanent choice of a GP, which can be printed from the website of the National Health Insurance Fund (NHIF). Only the fields with the patient’s data are to be filled out, while the other information is filled out by the newly selected doctor, who has to have a contract with the Fund. There is information that also has to be filled out in the health insurance booklet, which remains with the patient and its number is entered in the form of a permanent choice.

The new GP has to undertake his/her responsibilities from the date he/she was selected.

Patients with health insurance have the possibility to change their GP two times a year – in December and in June. At any time of the year it is possible to make a temporary choice of a doctor when it is necessary – as in the case of residing for over a month (but not more than five months) in another city. The form for a temporary choice of a doctor is also available on the website of the NHIF.

User fees for pensioners should not be increased, but a way should be found that they are compensated. To increase the tax for the rest of the people is also not a solution. He indicated that in most European states there is alleviation for seniors.

To say nothing that there are states where they have been covered by the state or the health funds. It is not clear whether a populist decision is not at the expense of the health units, he added.

Before the beginning of the conference “The patient at the center of the system,” dedicated to the priorities in healthcare, the former Director of the Military Medical Academy, now an MP from GERB and chairman of the health committee in the parliament, commented the schedule  set by the Health Minister Petar Moskov and included an electronic health card, the basic package of activities to be undertaken by the Health Fund, and those who would be taking up the health funds, the contracts with hospitals, etc.

This type of schedule should be accepted before the budget. It should be corrected according to the budget possibilities. According to such a schedule timeframes should be set which would be the basis for the conversations with other subjects – the BMA, patients’ organizations. The problem is at the expense of what and whom should the reform take place. The patient is most important, his/her requirements and to what degree the financial resources, which the state could provide, are important to the patient. The patient has to control the funds which come with him/her. There is the question about the effective use of the funds for healthcare and the controlling organ should be the Health Fund. Part of the control functions of the audit and the ministry should be transferred to the NHIF. But this is among the priorities of the health minister.

With regard to the idea of merging hospitals on a regional basis General Tonev said that the problem in this merging is it should not lead to even greater costs for the system.

The electronic health card would allow the Ministry, the Health Fund, and the hospitals themselves to receive direct information flow, which at any time would be able to indicate where the patient is, what has been done and how much it costs. Of course, there is duplication of activities, and they lead to the payment of the same meaningless service. The main problem is the lack of coordination, the question is more organizational, he said.

There is a possibility that the user tax pensioners pay when visiting their GP will stay 1 BGN. The Ministry of Finance intends to not pay GPs the funds with which to cover the difference up to 2.90 BGN as is the regular user fee next year. This was announced by the chairman of the Bulgarian Medical Association, Dr. Tsvetan Raichinov. He also specified that the BMA will withdraw from the signing of the National Framework Agreement, if that happens.

The reduced fee for pensioners visiting a doctor is absolute discrimination against the rest of the population was explicit Raichinov. “By what logic will everyone else pay 2.90 BGN, as if we were of another category. The prior intention of the Ministry of Finance was the fee to remain 1 BGN for pensioners and not to be compensated, which the Medical Association cannot accept. The Ministry has not foreseen the 15 million needed for the payment of this fee in its budget. If this happens, I can guarantee now that there will be no framework contract and the Medical Association will withdraw from the other institutions in the country. This cannot be approached purely mechanically. These are things that doctors do and therefore they cannot be taken from there. If those 15 million BGN would solve the problems of the country – good. Well, there would arise another small problem – no doctors will be left, especially in the rural areas, but I think that this country does not seem to be bothered by this,” – he said.

Doctors will agree to a NHIF budget for the next year which would amount to the same sum as this year’s plus 325 million BGN, said Tsvetan Raichinov after a meeting with the Health Minister Dr. Petar Moskov. “This is a budget that is realistic for the next year, in order there to be predictability and tranquillity in the system. If the budget is less than this year’s plus the two updates, there will be no framework agreement, ” – said the representative of the BMA as well.

Issued on paper forms will no longer be valid

From the beginning of next year doctors will submit electronically medical sick notes in the National Social Security Institute (NSSI) and after December 31, issued hospital paper forms will not be valid. This was announced last week by the Institute. The reason for the change is the operation of an electronic registry of medical sick notes that starts from the 1^st of January 2015.

From the 1^st of December this year the registered in the NSSI medical institutions can receive unique numbers for the medical sick notes from the local offices of the Institute or online via a web application. Doctors and the medical institutions have to be registered as users the of web services provided by the Institute starting the same day, which will facilitate the exchange of data between the system and the electronic register.

The registration is done through a web application accessible through the website of the Institute. For this purpose, doctors, medical institutions and individual practices have to hold a valid certificate for a qualified electronic signature.

The NSSI reminds that the receipt of unique numbers of medical sick notes and making them available to the doctors is the responsibility of the heads of the medical institutions.

The medical institutions, which are not registered in the NSSI, have to submit an application form (together with the registration of the medical institution) from the 1^st of December to obtain unique numbers for the medical sick notes in the territorial division of the NSSI.

For the issuing of medical sick notes after the 1^st of January 2015 it is obligatory to use the software distributed by the NSSI free of charge or any other programs with defined requirements, published on the website of the Institute. They are intended for the software developers used by the medical expertise authorities and the medical institutions.

Beta-blockers are an indispensable element of drug therapy in heart failure (HF). Several multicenter trials have confirmed the beneficial effects of some of them on the survival, hospitalizations, morbidity, and the various clinical aspects of this disease.

The treatment with beta-blockers reduces hospitalizations (total and cardiovascular in HF), improves the functional class and leads to delayed worsening of HF. This benefit has been consistently observed in subgroups of different age, sex, functional class, left ventricular ejection fraction (LVEF), ischemic or non-ischemic etiology (Grade of recommendation I, level of evidence A).

In patients with LV systolic dysfunction, with or without symptomatic heart failure after acute MI, long-term treatment with beta-blockers in addition to ACE inhibition is recommended, in order to reduce mortality (degree of recommendation I, level of evidence B) .

In patients with HF there may be differences in the clinical effect of the different beta-blockers. Four beta-blockers are mainly recommended for the treatment of HF, depending on the case – bisoprolol, carvedilol, metoprolol succinate or nebivolol (degree of recommendation I, level of evidence A).

What are the differences of carvedilol in comparison with the other three?

In addition to beta-1, carvedilol blocks beta 2 and alpha 1-adrenoceptors and has antioxidant properties. Sarvedilol improves the left ventricular ejection fraction in patients with chronic heart failure (CHF).

Moreover, in cases of CHF and left ventricular dysfunction after myocardial infarction (MI), the treatment with carvedilol limits the remodelling of the left ventricle.

The study COPERNICUS- Carvedilol Prospective Randomized Cumulative Survival Study (with 2289 participants) demonstrated that carvedilol significantly reduced mortality and hospitalizations for severe (grade III-IV in NYHA) CHF. Another study – CAPRICORN -Carvedilol Post-Infarction Survival Control in Left Ventricular Dysfunction (1959 patients with LV systolic dysfunction after-MI) demonstrated the beneficial effects of carvedilol in infarction condition – that it reduced mortality.

The particular importance of the antioxidant properties of carvedilol are as follows:

– Reduction of the oxidative stress on cardiomyocytes – a delay of the remodelling of the ventricular wall;

– Reduction of the importance of the “reperfusion syndrome” – in some patients with MI and reperfusion  a fulminant HF is developed afterwards. Sarvedilol limits the “oxygen shock” on the cells;

– Improving the opportunities for the production of nitric oxide.

What is the importance of the alpha-1 blockade induced by carvedilol?

In HF the heart works with a decreased flow, against an increased peripheral vascular resistance.

By blocking the alpha-1-adrenergic receptors in the periphery, carvedilol causes vasodilation, reduces the peripheral vascular resistance and hence decreases the afterload of the heart, therefore, limiting the hypertrophy of the left ventricle and the subsequent diastolic dysfunction.

Hence the additional effect of carvedilol on the development of HF – functional class improvement, and improvement of the quality of life.

Tchaikapharma – High Quality Medicines Inc. produces licensed Dilatrend (carvedilol) and is a Marketing Authorization Holder of the product.

Dilatrend has been in the list of NHIF since the 16^th of November 2014, with the following codes:
Dilatrend 6.25 mg x 28 tabl. – CG 221
Dilatrend 12.5 mg x 28 tabl. – CG 220
Dilatrend 25 mg x 28 tabl. – CG 219