Prof. Gencho Nachev, Director of University Hospital St. Ekaterina: BGN 350 mln are sufficient for the reform of the emergency aid services

Sonia Stamboliyska

Professor Nachev, Reuters released information that Minister of Health, Bozidar Nanev claimed that after implementation of the health care reform, state hospitals could be privatized. The MoH denied this information. What do you think of ideas like this?
- I am not familiar with this claim. State hospitals cannot be privatized because they are in the list of companies banned for privatization. However, I want to say that privatization is not entirely excluded. If the privatisation of hospitals would lead to improvement in the quality of treatment and management, there is nothing wrong whit it. I repeat however that there is a list of banned for privatisation companies, which includes university and regional hospitals. They are considered the backbone of the health care system and it is through them that the health care strategy is implemented. An special act of the Council of Ministers would be needed to remove them from this list. In my opinion, the public-private partnership principle must be implemented more broadly in our hospitals - they can remain state -owned, but an opportunity for investment and the influx of fresh money into the system must be opened. In times of crisis, this will improve the quality of the services.

How would you comment on the protests of small hospitals that fear that will be closed down?
- The purpose of the reform is such that every Bulgarian citizen no matter where would be able to obtain the same healthcare services. Thus, the university hospitals supported the reform. As directors of these hospitals, we are facing the problem that patients often come to us when their treatment has already been delayed. In this case, even if we succeed to heal a man, he could not return to the state in which he was before he got sick. Therefore we say that there must be criteria, determining the level of competence, in accordance to which each unit in one hospital can do or not do something. These criteria are: equipment, highly professional staff, 24-hours patients’ access. These are standards that were set by the experts. But before all this to start there should be information preceding and explaining the changes. I see as a fault of the Ministry of Health that it did not carry out a competent communication campaign to inform the medical community and the society about the reform. The Ministry of Health, started to organise meetings, all over the country in the last two - three weeks, to explain the restructuring process, but this had to happen much earlier. If they had done this, maybe there would not be any protests.

How should the reform be carried out in small settlements with no good-quality medical assistance?
- The analysis from the last few months shows that some 20-25% of the people hospitalized in small hospitals have really needed such treatments, while the remaining 75-80% have only stayed to occupy the beds. This is in fact draining of money from the National Healthcare Insurance Fund (NHIF) because DRGs (diagnosis-related groups) are needlessly reported when people can be cured at home. A very strong specialized pre-medical assistance, available round the clock, must be established at the places where hospitals for active treatment will be closed down. Money for the purpose has been earmarked in NHIF’s budget.
The next thing to be done is to reform the emergency medical aid sector which is well equipped. The personnel there must be motivated not by financial incentives alone, but with possibilities to develop, i.e by offering specializations, opportunities for carrier development, etc. However, we have to note here that money is needed for everything, and such a reform cannot be accomplished with the presently available budget. On the other hand, money cannot be poured into a fund with a 'sieve bottom'. Therefore, we have to start the reform and we have the Finance Minister’s assurance that BGN 350 mln will be set aside additionally for the restructuring of hospital assistance in June. We have to support the reform at present and we will see in the process what else should be mended.

About BGN 700 mln would be necessary for the restructuring of the Emergency Assistance. Where will this money come from?
- In the first place, this BGN 700 mln, is hyperbolical, in my mind, and secondly – we are speaking about a three-year period. This figure has been calculated on the grounds of beginning from nothing at the Emergency Assistance. But we do have some equipment. BGN 37 mln has been set aside now, which is insufficient. According to me, if BGN 150 mln is set aside during the first year, and BGN 100 mln in each of the second and third year, this money would be sufficient to fully reform the Emergency Assistance.