Major General Prof. Stoyan Tonev, MD, Head of the Military Medical Academy: The Health Insurance Fund should be less dependent on the Ministry of Finance

- Prof. Tonev, what is your assessment of the ongoing health reform?
- The health care reform is a problem of the entire society, not just of doctors or the Ministry of Health. Moreover, there are things that should be done this year despite the elections. First of all – the National Health Insurance Fund (NHIF) should become less dependent on the Ministry of Finance. Everyone understands that healthcare is not only a subject to strict economic requirements, but it must meet social needs as well. Furthermore, it is important for the voluntary health insurance funds to be triggered. They are active even now, but their resources are small – BGN 30-40 mln, given that the funds for healthcare exceed BGN 2 bn.

- Do you think you are able to persuade good specialists not to seek professional realisation abroad?
- Yes, both by purely professional and by financial motivation. We regularly pay their remunerations, associated with the NHIF. Of course, it is very difficult. It is particularly difficult for the young specialists. Very often they are seduced by the relatively higher wages abroad, as in medicine the process of accumulating skills is slower than in other professions. Of course, it comes down to specific areas where there is a shortage not only in Bulgaria, but worldwide as well, such as anaesthesiology, traumatology and pahtho-anatomy.

- What is the financial condition of hospitals in Bulgaria according to your opinion?
- This is the core of the health reform. However, the lack of funds in the budget should not be considered as a major problem. The State allocates as much money as its finances allow. We have just to look for other funding streams, in order to ensure the reform, because right now the health system is based on three pillars. One of them is the Ministry of Health, the other - the NHIF, and the third – the voluntary health insurance funds. Unfortunately, the crisis had to come in order for us to start restructuring the hospital care and changing the funding of the system. We could do it 15 years ago.

- Will the new funding scheme to be introduced in 2012 help to overcome the insufficient financing in the healthcare sector?
- The new funding scheme has to achieve several goals: in the first place - less dependence of the NHIF on the Finance Ministry and fixing the basic package of medical services, paid by it; in the second place - development of the voluntary insurance funds, and thirdly – introduction of professional healthcare insurance. Lack of investment is the main problem which medicine in Bulgaria faces. Investments from the EU are greatly relied on and the Health Ministry is working very ambitiously for them.

- What are the risks of replacing the currently existing DRGs with new ones?
- The new diagnosis-related groups (DRGs) offer a very good way of financing because they stipulate provision of funds not only for the main ailment but also for any accompanying diseases of the patient. However, these cannot be introduced immediately since time for preparation and considerable financing is required. Germany, for instance, needed a year and a half to do this.

- When the real effect of this change will be felt?
- I believe that the new DRGs cannot be fully introduced earlier than in seven or eight years, but the process should start now because any postponement will result in a delay.

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