Bulgarian healthcare is “sick“ – such a diagnosis was made by Dr. Nikolay Boltadzhiev, a former member of the Supervisory Board of the NHIF from the employers' quota, in a conversation on the program “Face to Face” on bTV.
According to him, the causes of the problems in the system are mostly related to the way healthcare is managed.
“It is sick of bad management, of bad politicians“, said Dr. Boltadzhiev. He emphasized that neither patients, nor doctors, nor hospitals can change the basic rules, because they are created through laws.
“Laws are built by politicians. As we see, scandals are usually related to laws, not to something that is illegal“, he said.
According to Dr. Boltadzhiev, the problems in the system are the result of a combination of ignorance of the processes and strong interests.
“I think, in my opinion, it is a combination. I see both ignorance and lobbying, very strong lobbying in healthcare," he said.
As an example, he pointed to the issue of public procurement for medicines paid for by the Health Fund. According to him, this is not an effective way to reduce costs, because the problem is not only whether hospitals make public procurements.
“This is not a way to solve the problem“, he said.
As a solution, Dr. Boltadzhiev pointed to the NHIF directly negotiating the prices of certain medicines.
“The Fund should purchase these medicines, i.e. negotiate them as it negotiates other medicines“, he explained. According to him, this will allow better conditions to be achieved.
„Then it will negotiate prices and pay at these prices, just as it pays for insulin, just as it pays for other medicines that the health insurance fund covers, just like in all of Europe“, said Dr. Boltadzhiev.
According to him, the reluctance to change is also related to the interests of various groups.
„There is mainly the pharmaceutical industry“, he said when asked who has an interest in the system remaining unchanged.
According to him, public procurement often leads to higher prices.
„We know that in healthcare, everything that is purchased through public procurement is much more expensive, even many times, than what private hospitals buy without public procurement“, he said.
He made a distinction between state and private hospitals establishments.
„State hospitals spend foreign money. It doesn't matter to them how much they will buy a piece of equipment, while the private sector, when buying medicine or equipment, takes this money out of its own pocket“, said Dr. Boltadzhiev.
The conversation also raised the question of why the same people continue to participate in the management of the healthcare system, despite the constant problems.
„We see a new government with a large majority, but the people are the same. Exactly the same“, commented Dr. Boltadzhiev.
According to him, politicians often blame the system for problems that they themselves created.
„I have heard MPs, doctors in the health committee for years reproaching that there were many hospitalizations and many hospitals. Yes, but I ask — when they reproach, who are they reproaching? Only they, the politicians, can do this, because they did this thing“, he said.
Dr. Boltadzhiev also explained why there are so many hospitals, pointing to the development of eye care.
According to him, in the past many eye surgeries were performed on an outpatient basis, but after changes in the regulatory framework, some medical centers were forced to register as hospitals.
“Here are 40 more eye hospitals“, he said.
According to him, the solution is not the mechanical closure of medical institutions, but a change in the way medical care is organized.
“They need to move all outpatient activities outside of hospitals. These are at least a third of the clinical pathways. "They can work on an outpatient basis," said Dr. Boltadzhiev.
According to him, the restrictions on outpatient care also lead to unnecessary hospitalizations.
“The patient very often does not have access to hospital care. There is no access to outpatient care. There are also limits there, as in hospitals. Very severe limits“, he said.
According to him, doctors are often forced to refer patients to hospitals so that they can have tests and procedures performed.