BND`s position for:

The vanguard idea for the demonopolization of the National Health Insurance Fund (NZOK) was presented by Bozhidar Nanev – part of the medical services provided by NZOK to be managed by private funds. This is one of the proposals of the Citizens for European Development of Bulgaria (GERB) party that are intended to reform the sector. It is possible for specialized pre-hospital care and the highly specialized activities and tests, which are currently provided by NZOK, to be given to private health insurers, Nanev said. The insurance deposit will be kept at 8%, but part of it will be directed to private businesses. This would mean the patients will continue to be examined by specialists and will receive the same service packages, however, the physicians will get their money not from NZOK but from private insurers. The doctors will not negotiate prices with NZOK but with other funds. Private companies will manage the money for these services, whose budget is now 154 million leva. The patients will chose themselves which fund will provide their pre-hospital specialized care. The goal of the change is to encourage voluntary insurance, whose market at the moment is only 30 million leva, in order to have more money entering the system, the Health Minister explained. The general practitioner will still issue referrals to send the patient to a specialist and referrals will remain unlimited. But those, who do not wish to wait for such documentation, would have the opportunity to pay 30% of the price of the exam – in cash or through additional insurance and obtain direct access. The change will eventually be introduced in 2011. It is still unclear if it would become part of the amendments of the Health Insurance Act prepared by GERB.

The Bulgarian New Democracy (BND) has long supported the idea to revitalize the activity of private funds for voluntary insurance. We see the role of those funds not only as a possibility for additional insurance, but as a possibility for more effective and frugal spending of the funds from mandatory insurance. However, at this stage, we don't believe the health care reform would  profit if part of the mandatory insurance deposits collected from the public are granted for free to private funds. A more pending step for the complete reform of the sector and a real revitalizing of the funds' activity should include an amendment of the Health Insurance Act that would introduce a regulated copay in the health care sector. In addition, the amendment must provide for the establishment of a fund with the Labor and Social Policy Ministry to ensure copay for disadvantaged citizens. This way, the resources of the mandatory health insurance, the financing of health care activities through budget programs and the additional voluntary insurance will secure a solidarity, prepaid by citizens, health care where:

1. Paying cash under the table will be eliminated.
2. Everyone will have access to the same quality basic health care
3. The financial resources will be directed by the patients towards health care facilities and doctors selected on the basis of the quality of their services.

We from BND believe that after copay is regulated, after NZOK begins to declare a clear package with reality based prices for each clinical activity, after the voluntary funds begin functioning and the privatization is freed up, only then the real restructuring of the health care sector, based on marker principles, will begin.