We asked him for a comment as we have a report on the NHIF budget for the period 2009-2014 which clearly shows that he althcare spending in the 5 years in question has almost doubled from 1 billion BGN 695 million in 2009 to BGN 3 billion 171 million in 2009. What are the conclusions of this phenomenon, why do the institutions constantly explain that there is not enough money for he alth, which is why the services for people are not fully paid by the NHIF?
On these and other issues, we talk to Dr. Katsarov, whose organization has been conducting breast cancer screenings in cities and palanquins across the country for the 6th year, financed by Raiffeisen Bank under the "Choose to you help".
Dr. Katsarov, the he alth insurance payments of the NHIF increased from BGN 1 billion 695 million in 2009 to BGN 3 billion 171 million in 2009. - how do you explain this fact?
- Yes, it comes mainly from the increase in the Gross Domestic Product (GDP), unrelated in my opinion to the increase in he alth contributions a few years ago. 4.3% of GDP is the he alth care subsidy in these years, but the GDP itself is changing. Costs in the he alth care system have increased by about 10% per year.
Therefore, in 2015, the expenditure of the NHIF should be around BGN 3 billion and 400 million, or with another 10% on top. This means that the deficit of the NHIF for the year it will be quite large. For m.y. the expenditure of the NHIF is BGN 3 billion and 171 million, but the funds actually paid out are about BGN 3 billion, i.e. we have a BGN 170 million deficit a priori, it is guaranteed, compared to what was paid in 2014. If we also add the trend for a 10% increase in expenses, this deficit of the NHIF will reach BGN 300-400 million. BGN for this year The biggest boom and bust is in medicine and hospital care.
Why are the expenses for the maintenance of hospitals increasing so drastically - from 976 million BGN 5 years ago to 1 million 685 million BGN per year?
- Costs are rising because the number of hospitalizations is increasing, and they are more because they introduced the medical standards. Thus they administratively increased the number and costs of staff in hospitals. If you replace two doctors with six, it means that you have increased the salary fund three times. More than half of hospital costs are for salaries and employee benefits. Because the cost of the clinical pathway is fixed, the only way to increase revenue and offset these administrative costs is by increasing the number of patients treated. Therefore, we reach a growth in hospitalizations of 1 million and 500,000, as they were until 2008, this year I think they are over 2 million. There are quite a few people who could be treated without going to hospital.
Now the minister plans to transfer part of the activities in pre-hospital care…
- Yes, it doesn't need to be thought about, it has to be done. We have reviewed the clinical pathways that
can withdraw from hospital care,
and it became clear that a third of them, i.e. about 100 clinical pathways, it is quite possible to serve them in the pre-hospital sector. This can be done, it is determined by an ordinance.
Do you think the current hospital budget limit measures will work?
- These measures are not new, there have been limits on hospital budgets for several years and they always cover the deficit with a budget update. Limits will lead to bankruptcy of municipal and state hospitals, or they will stop accepting patients - this is not the way to save money.
There is work to be done in terms of drug supply. The costs will not be able to be reduced in my opinion, but the growth can be reduced - not to double the amount in 5 years, as it is now. And from your report it is clear that in 2009 the expenditure on drugs for home treatment was BGN 325 million, and in it is already BGN 644 million
In my opinion, a better selection of what is covered by the NHIF can be made, mechanisms are now being created to negotiate discounts, and an assessment is also being prepared for the introduction of pharmaco-economic efficiency, with a view to this not every molecule that enters the market to enter the reimbursement list of the Cashier. A cost-benefit assessment of the drug should be made. These measures will give results in terms of stopping the cost of medicines.
They always give as an example that the amounts of cancer drugs have increased dramatically in recent years - what do you think is the reason for this?
- There are more of them and the sick, and they all receive medicine - that's why the costs are higher. How many times have we condemned the Ministry of He alth for not providing medicines, less than 50% of people were getting medicines 3-4 years ago. Now that the NHIF pays for them, everyone has access to the drugs, so it is normal for costs to rise. In addition, new and better drugs are introduced, people's lives are extended, but they use drugs for a longer time, which also leads to an increase in spending. The prices of oncology drugs also increased because it was made so that each KOC or oncology hospital negotiates the supply of the drugs by itself. I've always been of the opinion that it
better NHIF to negotiate the prices
and they should be the same for everyone. Now I think centralized price negotiation for oncology drugs will return.
How will you comment on the intentions and actions of Minister Moskov for reforms in the sector?
- Reforms can be much bolder than what is being proposed. In general, the measures are rather positive. The funds for he alth care are really not much, it is unthinkable to compare them as gross amounts, convert them into euros and see how much is spent in France, in England, etc.n. 5.7% of GDP is the average value of he alth care costs for the EU, in our country the funds are less obvious. So I think we are getting more services than expected with this funding.
The general mistake is that they see the he alth system as an administrative and social activity, and they cannot understand that it is a profitable business.
In my opinion, this is at the root of why all attempts at reform have failed. They originate from the wrong understanding that this is an expense of the budget, and it is a profitable business, even for the state. It pays BGN 900 million per year for the he alth insurance of adults, children, soldiers, civil servants, the socially weak, etc., and BGN 350 million for the budget of the Ministry of He alth. This is the expenditure of the state budget - BGN 1 billion 250 million in total.
The annual turnover for he althcare activity in our country is about BGN 7 billion - 50% of the costs are paid manually by the patient. Only VAT on BGN 7 billion is BGN 1 billion and 400 million, because all medical services are subject to this tax.
So the budget is in the red from the he alth system, not in the red right now. Instead of trying to increase this plus, the state is wondering how to crush the hen that lays the golden eggs, introducing new restrictions, orders, stopping competition with the ban on opening new hospitals. Let them compete, it will bring you profit. The users will be most satisfied with this.