Professor Grigor Gorchev, Managing Director of the Specialized Obstetrics and Gynecology Hospital for Active Treatment ''St. Marina'', Pleven: Over 3% of the health insurance contribution are lost in the informal sector

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- Professor Gorchev, a few days ago the ABR (Alternative for Bulgarian Revival) civil movement issued its standpoint on the healthcare system, called "Alternatives for the Healthcare Sector". Since you have been involved in its preparation, would you tell us what does this programme propose?
- The project was hammered out a year and a half ago and was presented at a roundtable in the city of Plovdiv, which was attended by many leading experts in the healthcare field. The future prospects of a reform have been discussed for many years, but it has not been implemented yet. Some of the ideas set out in the overall concept are related to the increase of the health insurance contribution up to 8%, which now stands at exactly the same percentage. However, less than 5% of this amount are actually utilised for healthcare services. In fact, the remaining 3% are lost in the healthcare informal sector because the money are mainly distributed 'under the table'. Therefore, we demand that the actual circulation of the health insurance contribution be brought to light and be used solely for the provision of healthcare services. As regards the hospital reform, I would like to emphasise that the scheme for formation of physicians' remunerations should be changed. Currently, the doctors' emoluments are based on the influx rate of patients, while they should be calculated on the basis of the quality of treatment. Many patients are admitted, for example, in hospitals, where they can be treated mainly by GPs. In the first place, the provision of a high-quality healthcare service must be sought. The other important issue in terms of hospital care refers to the proper health insurance, provided to the patients themselves. Currently, it depends on the NHIF (National Health Insurance Fund), but actually a three-pillar insurance scheme should be drawn out and it should also incorporate the voluntary insurance installments. This is very important and I think that in this way the attention will be focused primarily on the quality of the offered medical treatment.

- You said that the management of the healthcare system was too centralised and bureaucratic. What solutions do you propose?
- The most important thing is to introduce the principles of competition between hospitals. Competition itself offers quality, therefore the market should be regulated. That is, the market mechanism should be enabled to operate. It should be also indicated, however, that there are many health uninsured patients. This is a big problem since uninsured people include not only those experiencing financial hardships to pay their insurance contributions, but also people who are financially stable and could afford their self-insurance. A special attention must be paid mainly to those patients by drafting of a legal mechanism for monitoring of regular payments of healthcare insurance contributions. I would propose the existence of such a mechanism. In order for the quality in the healthcare system to be improved, the market of medical services should be legalised and, primarily, the cost estimation schemes must be properly drawn out. Currently, we cannot resort to any cost estimation of services, which is causing big problems.

- In your opinion, how should the hospital care system be reformed?
- This issue is very extensive so as to answer you with a few sentences. The reforms should aim at the reduction of the number of university hospitals. Currently, only in Sofia there are 18-19 university hospitals, while Tokyo has three and Athens has two such hospitals. Their general number for our country reaches 22. It is not normal to have that many of them solely in the capital. In Sofia, 2 university hospitals, or maximum 3, must be located, and one in each of the large cities - Plovdiv, Varna, Pleven and Stara Zagora. The reforms in the hospital system should also include minimization of the duplication of structures. We propose a model for reform in our project, which has already been submitted.

- The Health Minister announced last week that he was ready to provide a funding model through the scheme of diagnostic related groups. Do you think we are prepared for its introduction?
- This is a good idea, but additional funding is needed in order for it to be implemented. The State should provide financial resources for the realisation of this project.

- On Wednesday, representatives from the Bulgarian National Patients Organisation reported that hundreds of cancer patients remained currently without their life-saving therapy due to lack of medicines because hospitals' tenders for the purchase of oncological medicaments are not over yet. How can this problem be solved?
- The problem with the drug deficiency will be solved when the medicine supply tenders are held by the hospitals. The current transitional period will be sson over and afterwards things will stabilise. There is no doubt, however, that it is normal for the tenders to be conducted by the medical establishments, rather than be carried out in a centralised way. Currently, technological time is needed in order for the procedures to be regulated.

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