Dr. Iavor Drenski, CEO of Tokuda Hospital: The State discriminates against patients

Sonya Stamboliyska

- Dr. Drenski, the National Healthcare Insurance Fund announced that according to hospitals’ managers, the money earmarked for this quarter would be sufficient. Do you share this opinion?
- Even back when the limits were introduced, the methodology for their calculation was not set well and perhaps in its effort to enforce them faster the NHIF failed to achieve its purpose, which was to force hospitals optimise their activities and reduce costs. Thus, just the opposite effect was achieved. Instead of making hospitals’ managements strive to optimize their activities, the problems in the medical establishments deepened. They became even more serious when the limist for 2011 were set. The targets did not take into consideration something very important for every hospital on the market, namely the constant development and improvement of quality. The limit for Tokuda was reduced by 18% this year, compared to the amount paid in 2010. This answers the question as to whether the budgets are sufficient or not.

- You said that the funds under DRGs (diagnosis registered groups) were not sufficient. Can any other forms of surcharge be considered?
- Surcharge is a common practice in many countries. In Japan, for example, 30% of the cost of thetreatment is paid by the patient. This would be beneficial because being included in the direct financing of their treatment, patients would be much more responsible and demanding. They would certainly ask a second opinion in order to make sure that the prescribed treatment is exactly the one they need. This means that patients would control the system which is very important. In addition to the insufficient financing of DRGs, there is also incorrect and disproportionate distribution between the different medical specialties. This can be avoided by the introduction of Diagnosis Related Groups. These enable financing institutions to allocate the available money proportionally depending on the severity of patients’ illnesses in one or another group.

- Smaller hospitals complained some time ago that they might not sign contracts with the NHIF because of the requirements introduced. How would you comment on this issue?
- Requirements to the quality of medical care should certainly exist. This is just normal and is associated with the existing premises, equipment and personnel. These are mandatory conditions for ensuring good quality. This is how it should be. Regretfully, since DRGs are drafted by consultants in the respective medical specialties rather than by a team from the NHIF, these three requirements served rather for lobbyism than for what they had to. The people drawing DRGs subordinate the requirements to the respective DRG to their own medical establishments. The aim is to direct (if possible) all the patients to the hospital in which the consultant who drafts the DRG works. This is the subtle point that turned DRGs into a tool of lobbyism. Standards were set in the same way. They must exist, but regretfully, a framework was set when standards were drafted. Each specialty should fit in the framework approved by the Health Ministry and comply with it when setting the requirements for the activity of the respective department. This immediately led to paradoxes and these are in that they set mainly requirements to the structure rather than to the activity, while medical standards must regulate the activity.

- Do you think that private hospitals in our country are being discriminated against?
- The most powerful tool for the development of private hospitals is their attention to patients. Medical establishments must create comfort for patients’ treatment. For this purpose we have created an unit to work with patients. Its aim is to be ready to react at any time to any complaint by a patient in order to improve our activities. If a patient wants to, he or she can always come and talk to me. I would not say that private hospitals are being discriminated against, although it might look as if this was so. Under a decree of the Council of Ministers, we cannot get medicines for treatment of oncology diseases. It might look as if the hospital is being discriminated agains,t but this is not important in this case. The big problem is that patients are being discriminated against. We have instances of patients who prefer to borrow money and buy the necessary medicines themselves in order to come and be treated in our hospital.

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