The Bulgaria 2010 Review: Health

Society » HEALTH | Author: Maria Guineva |January 6, 2011, Thursday // 21:38
Bulgaria: The Bulgaria 2010 Review: Health Stefan Konstantinov, the third Health Minister Bulgaria got in 2010. Photo by BGNES

2010 health news were marked by several reshuffles at the health ministry; doctors and patients disgruntled over healthcare budget cuts and poor conditions at healthcare facilities and the replacement of the full smoking ban with a partial one.

Health Ministry Reshuffles

On March 31, Bulgaria's Prime Minister, Boyko Borisov, accepted the resignation of Health Minister Bozhidar Nanev after he was charged over a "Tamiflu" order scandal.

Nanev became the first acting minister from the cabinet of the ruling Citizens for European Development of Bulgaria (GERB) to be officially charged by the City Prosecutor's Office.

Nanev is accused of conducting 2 unfavorable deals for the supply of the antiviral swine flu medicine "Tamiflu." The deals were signed on December 16, 2009 between the Health Ministry and the Bulgarian-based F.Hoffmann-La Roche Ltd. Company, and have, allegedly, caused damages to the Ministry to the amount of BGN 2 454 M.

The Sofia City Prosecutor, Nikolay Kokinov, insists Nanev had the opportunity to buy the swine flu vaccine "Tamiflu" earlier and at a much lower cost.

Nanev is adamant he had no other way to provide the much needed vaccine during the outbreak of the swine flu epidemic last fall.

On April 7 Dr. Anna-Maria Borisova was nominated by Borisov to succeed Bozhidar Nanev as Health Minister.

Prof. Borisova was at the time the Head of the Clinic for Metabolic Bone Diseases at the Sofia Endocrinology Hospital "Ivan Penchev" and the Head of the Bulgarian Endocrinology Union.

Her tenure lasted less than 6 months. She resigned unexpectedly on September 29, amidst heated public debates on the fate of controversial measures for health care reforms in the country.

Like Nanev, Borisova came under tremendous criticism for failing to start badly needed reforms in Bulgaria's crumbling health care sector as the National Health Insurance Fund has had to receive additional subsidies from the state budget, and the government has discussed shutting down dozens of hospitals in small towns around the country.

Borisova's resignation came several hours after she stated on TV the controversial measure of 20% copay by insured patients for hospital services would be introduced.

The PM generally made it clear that her premature statement necessitated her dismissal and pointed out Bulgarians have been paying bribes to get health care services so the introduction of a legal copay should be discussed seriously.

The very next day, Borisov nominated Stefan Konstantinov for new Health Minister to replace Anna-Maria Borisova.

At the time Stefan Konstantinov, a gynecologist, was deputy chairman of the Managing Board of the Bulgarian Doctors' Union and member of the Board of Directors of hospital "Nikola Vassilev" at the town of Kyustendil.

The newly appointed Health Minister vowed to establish clear rules concerning payment and treatment in all hospitals and to purchase foreign-manufactured software to use it in determining prices of hospital care.

He also declared copay for medical care must be extended beyond hospitals, but it must be small and affordable by all patients.

Under the new rules, the patients would no longer need a referral from their GP in order to consult with a specialist while copay will force them to seek doctors' help only when really needed.

Major hospitals will receive priority financing and adequate equipment and staffing with patients informed in advance which hospitals would be included in the priority list. The rest would not be closed, but copay there would still be required, the Minister explained.

Reshuffles were also made at Bulgarian National Health Insurance Fund (NZOK).

On April 27, Doctor Neli Nesheva was nominated the new NZOK head. She was Secretary General of the Bulgarian Health Ministry. Her appointment came as a follow-up to the untimely termination of her predecessor's mandate when a week earlier the Bulgarian parliament removed Zheni Nacheva from the post over alleged abuse of power.

Nacheva was accused of unlawfully increasing the budgets of three medical establishments throughout the country.

Doctors' Protests

In mid-September, the Doctors' Union declared they are ready stage a nation-wide protests in demanding the resignations of the Health Minister and the Finance Minister over the troubles in the health sector.

Health Minister Anna-Maria Borisova gave in to calls for her resignation and quit in the face of the public anger.

At the end of the month, the Bulgarian Doctors' Union called on prosecutors to launch a probe into the accounts of the state Health Insurance Fund, claiming BGN 319 M went missing from them in 2009, something the NZOK head firmly denied.

Tsvetan Raychinov, Head of the Union, announced on the same day the protest was still on and could be canceled only if the hospitals receive at least half of the BGN 125 M that NZOK owed them.

Doctors complained all over the summer of the "self-willed and unlawful actions of the National Health Insurance Fund", which according to him must pay to hospitals for activities they have conducted and not based on a monthly budget and insisted that due to the cuts in funding hospitals in Bulgaria will not be performing planned surgeries, unless patients pay for themselves all consumables. They also threatened to stop the planned hospitalization and to provide medical services only to the emergencies

The outrage was stirred in the beginning of August when heads of hospitals have been asked to sign annexes to their individual contracts with NZOK, envisioning serious cuts of their budgets.

The expenditures for hospital care are consistently going up over the decision of the previous cabinet to use NZOK to finance hospitals, Finance Minister, Simeon Djankov, said and announced the Ministry will provide BGN 80 M for hospitals every month until the end of the year.

PM Boyko Borisov also promised that the money for the hospitals for 2010 will not be less than the funding for 2009.

On December 19, NZOK informed it is beginning to pay the November money to doctors and hospitals, adding with the transfer it had fulfilled her commitment to make up for the delay in payments, which began at the beginning of 2009.

On December 23, the Health Ministry announced it will pay BGN 25 M more to hospitals for the activities it is financing. The funds will be spent on intensive care, emergency care, dialysis, psychiatry and others. They will cover 90% of what the Health Ministry owes hospitals for October, November and December.

Meanwhile, just before the holidays, Bulgarian cardiologists slammed the government for drastic cuts of funding for treatment of patients with cardiac dysrhythmia. According to the doctors, the funding slated for two respective procedures by NZOK is up to BGN 2 814, which is nowhere near the minimum of BGN 4 000 needed for such interventions. The doctors pointed out that Bulgaria ranks first in the EU in deaths caused by heart problems, accusing the cabinet for threatening the lives of hundreds of people each other in order to save a small sum of money.

Partial Smoking Ban Becomes Effective in Bulgaria

On November 3, the Parliament passed the smoking ban in indoor public spaces easing up the full smoking ban voted by the previous assembly, which was supposed to become effective on June 1, 2010.

According to the new ban, which became effective on December 19, owners of restaurants, coffee shops and bars must provide the necessary walls, tight-closing doors and good ventilation equipment.

The requirements will affect all smoking spaces inside commercial and administrative buildings, railroad stations and airports as well.

Owners of coffee shops and restaurants with less than 50 square meters have the right to decide whether smoking would be allowed. In case smoking is allowed, individuals under the age of 18 would not be admitted as they are banned from smoking in all indoors spaces.

In larger establishments, at least 50% of the space must be dedicated to non-smokers.

In night clubs, smoking will be allowed at all times regardless of how large they are.

Open-space coffee shops and restaurants inside shopping malls are becoming non-smoking facilities.

Owners face fines for inadequate ventilation and lack of sings designating the non-smoking sections and the smoking ban for those under 18.

Fines for owners range from BGN 500 to BGN 10,000. Individuals, who violate the ban, would also face fines, but only if they agree to provide their ID card.

Even though the smoking ban in public places came into force, reporters' checks across the country in the last days of the year have shown that it is being widely ignored. It may, however, be due to the delay in official checks, which will start at the beginning of 2011 to give an opportunity to make imporvements.

Similar measures were imposed as part of a partial smoking ban in 2005 but have been widely ignored.

Bulgaria ranks second after Greece in the EU in terms of number of regular smokers as a percentage of the population, according to a Eurobarometer survey.

Healthcare System in Shambles

Patients in Bulgaria are said to be the most dissatisfied with the access to medical treatment and the availability of drugs in the country.

Research by the Bulgarian National Patients Organization showed that 878 out of the 2706 complaints that patients have filed recently pertain to the limited access to care and drugs in Bulgaria.

Access to medical treatment is most often hindered by the limited number of referrals and the low reimbursement levels for home treatment drugs.

Representatives of the Bulgarian Association of Research-Based Pharmaceutical Manufacturers further insist Bulgarians are paying too much for their medicines.

According to their data, Bulgarian citizens are paying about 64% of the price of medicines, while the remaining 34% are covered by the state healthcare fund. The mean percentage for the EU of healthcare coverage of the price of medicines is much more – 80%. Pharmaceutical producers also pointed out to a 20% VAT rate for medicines, which for the EU is usually 5-10%.

In mid-December, Bulgarian pharmacies announced they will stop selling medicines that are reimbursed by NZOK until the end of December. The Bulgarian Association of Owners of Pharmacies cited as reason for the decision are the delayed NZOK payments to pharmacies. For October, NZOK reimbursed BGN 8.6 M instead of the required BGN 32-34 M.

On another issue, the executive director of the Bulgarian Donorship Program, Krasimira Velichkova, pointed out number of Bulgarians that have applied for outside sponsorship for treatment abroad has tripled. Velichkova says the Bulgarian Commission for Treatment Abroad persistently turns down applications by patients saying that Bulgaria offers the same quality of medical care as the one provided by foreign establishments, yet it allows Bulgarian patients to apply for outside funding in order to cover their medical expenses abroad. In addition, the Commission does not meet the required deadline of one month to notify the patients about its decision and many of the applications remain unprocessed, according to Velichkova.

At the end of May, several Bulgarian NGOs announced they were filing a class action complaint with the European Commission over systematic violations of health care rights in the country.

The initiative belongs to the representations of the "Active Consumers" Association and the "Bulgarian Center for Gender Studies" Foundation in the second largest city of Plovdiv over restrictions in the issuing of doctor's referrals. The claimants say there are many cases of discrimination because individuals who have the same health coverage are granted and denied referrals for same ailments without any grounds.

The Bulgarian Red Cross data shows that no more than 20-22 people out of 1000 donate blood voluntarily in Bulgaria, which leaves the country at the bottom of the ranking for blood donation in Europe. Under European standards, the number should be around 50.

Bulgaria's Health Ministry and the Bulgarian Red Cross, supported by the Bulgarian Orthodox Patriarch Maxim, organize a traditional blood donor campaign on Palm Sunday. The campaign, called "Light a candle, donate blood", seeks to raise awareness among Bulgarians of the need to voluntarily donate blood.

Emergency care is also said to be in tatters. A Sofia emergency room recently made headlines when an ambulance took over five hours to arrive at an address in Sofia's central "Lozenets" district, from the time the first call was placed. After making many unsuccessful attempts to get the ambulance to come from the emergency center, located at "Stochna Gara," near downtown Sofia, the grand-son of an 82-year-old woman in need of doctor's care, called the TV channel, seeking assistance. The emergency team finally arrived, just 20 minutes after being sought by the TV reporters.

AIDS Activists Outraged by Funding Cuts

More than 600 international activists staged a protest rally in Bulgaria's capital Sofia in mid-December during the meeting of the Board of the Global Fund to Fight AIDS, Tuberculosis, and Malaria is holding a meeting.

They were protesting primarily against the decision of the Fund to withdraw within one year its funding from Eastern Europe and Central Asia even though these are the regions with the fastest growing AIDS population in the world.

The Board of the Global Fund to Fight AIDS held a meeting in Sofia to reconsider the criteria that countries need to meet to qualify for the assistance from it.

Extension Granted to Hospitals Facing Closure

Bulgaria's Health Minister, Stefan Konstantinov, extended at the end of November the deadline for the closure of hospitals that have under the minimum required number of beds.

The change was made after a meeting between Konstantinov's Deputy, Dr. Mihail Mitev, and directors of municipal and private hospitals from across the country.

Just days earlier, the Bulgarian Health Ministry had issued a decree ordering the closure of small multifunctional municipal and private specialty hospitals across the country.

The decree, which was published in the State Gazette, set a requirement of a minimum of 60 beds for the multifunctional and 30 beds for the specialty hospitals in order to keep them open.

The Minister announced the deadline's extension, after the decree triggered outrage among hospital owners and threats to take the case to the Supreme Administrative Court

"Let me make it clear – no hospitals will close. This is a decree showing the right path to follow – the hospitals' optimization," Konstantinov said.

62-year-old Bulgarian Woman Gives Birth to Twins

In May, Krasimira Dimitrova, a 62-year-old from the Danube Bulgarian city of Ruse, became one of the oldest mothers in the world after giving birth to twins.

Dimitrova is also Bulgaria's oldest first-time mother by giving birth to twins an embryo transfer.

Dimitrova, who is soon to retire from her position as a psychiatrist, said that she was resolved to become pregnant after the authorities refused to let her adopt a child because of her age.

Georgi Hubchev, the doctor who delivered the babies, told the State BTA news agency that this was only the second case in the world of a successful in vitro to a woman aged over 60 resulting in the birth of twins.

The health condition of the two girls was very bad and one of them died.

The news stirred a huge debate in Bulgaria on whether age limitations should be imposed on women who want to conceive through an "in vitro" procedure.

In August, the Sofia Administrative Court canceled the order of the Bulgarian Fund for Assisted Reproduction, which has imposed an age limit of 43 years to women who want to conceive "in vitro".

The case has been brought by an appeal of a woman, who was refused "in vitro" because she had passed 43 years.

According to the court, the age limit is discrimination and it is against the Bulgarian Constitution and the Protection against Discrimination Act.

The regulations of the Fund for Assisted Reproduction do not include age limit. However, according to Act 28, doctors, as well as administrators, should comply with the imposed restriction that access to the fund's money is allowed only to women below 43 years of age.

Meanwhile, in October, Health Minister, Stefan Konstantinov, announced additional resources for the "Assisted Reproduction Fund" in the amount of BGN 5 M.

At the end of September, the "I Want a Baby" Foundation raised concern the Fund, better known as "In Vitro," is depleted and the Health Ministry had not transferred the money slated for it.

The fund grants up to BGN 5 000 to couples who have problems conceiving with each woman having the right to up to three attempts.

On the Positive Side

Swine Flu Tamed in Bulgaria

The swine flu epidemic was tamed in Bulgaria after the outbreak in the fall of 2009. The national consultant in epidemiology, Mira Kozhuharova, announced at the end of the year that one person died from swine flu (AH1N1) in Bulgaria 2-3 weeks ago. According to Kozhuharova, three people have been registered with swine flu so far and one of was a fatality. The two other infected are in good condition. She refused to name the city, in which the person has died.

Bulgaria Introduces Mandatory Breast and Prostate Cancer Tests

On December 22, the Health Ministry announced mandatory tests for breast and prostate cancer are going to be introduced in Bulgaria in 2011 The medical tests will be free of charge for people who have health insurance and will be covered by NZOK. The test will be mandatory for women between the ages of 50 and 69 and men over the age of 50 and will be done every two years with the goal to prevent the most wide-spread cancers in the country.

Food Agency Ready for Launch in Bulgaria

At the end of December, Agriculture Minister, Miroslav Naydenov, informed the entire country was ready for the Food Agency to begin functioning in Bulgaria, Friday.

The decision to establish the agency was made by the cabinet on November 3, 2010, with the approval of the Bulgarian Food Safety Agency Bill.

The project includes transforming the National Veterinary Service, the National Plant Protection Service, the National Grain and Grain Products Service, and the part of the public health body RIOKOZ dealing with food safety, into a sole entity – Bulgarian Agency for Food Safety.

The move will also reduce the staff roaster by 400 employees due to the scaling down of departments with doubling functions.

The agency will have 28 regional centers around the country.

Bulgarian Hospital Boasts Top of Line Diagnostic Ward

In December, Bulgarian Prime Minister, Boyko Borisov, launched the most modern image diagnostic ward in the country, located at the University Hospital "St. Ivan Rilski" in Sofia.

The ward is unique for the country with its complete set of top of the line image diagnostic equipment – digital, X-ray, computerized tomography, magnetic resonance, and others, while the renovation works took less than a year.

Bulgarian Scientists Make Breakthrough Medical Invention

It was announced at the beginning of November that a team of 34 Bulgarian scientists have invented a "faultless" nanorobot that is expected to revolutionize in vitro fertilization and other medical procedures.

The nanorobot, called "Hydromina," was created by the scientists from the Institute of Mechanics of the Bulgarian Academy of Sciences. It is designed to practically eliminate the human factor and human mistakes in the in vitro fertilization procedure.

The invention will allow doctors to carry out 10 000 artificial insemination procedures per day, whereas only up to 80 such attempts per day are possible at present.

The robot could also be used for other medical and medical research such as the injection of cancer cells for cancer research.

It took the BAS scientists 4 years to invent the "Hydromina" robot under a project funded by the EU and Germany with a total of EUR 473 000 to date. The Bulgarian State has not sponsored the project.

Nanorobot Hydromina will be enter into mass production but the process for that is expected to take some time. The production price of one of these nanorobots is projected to be EUR 30 000.

Unique Cervix Cancer Surgery Performed in Bulgaria

One September 24, the very first for Eastern Europe robotized surgery of cervix cancer has been conducted in Bulgaria.

The surgery was done by Prof. Grigor Gorchev, President of the Medical Academy in the northern city of Pleven and it is just the second one of the type in Europe. What makes the procedure unique is that after it the patient can still become pregnant and give birth.

Bulgaria's prominent surgeon is also behind the first in the country bloodless surgery of cervix cancer, carried out in 2004. In 2008, it was Gorchev again, who introduced the innovative practice of doing gynecological surgeries with the medical robot "Da Vinci" and founded the only tele-medical center on the Balkans.

State Drug and Medical Products Agency Launched in Bulgaria

In September, the Health Ministry announced plans to establish a new State Drug and Medical Products Agency to take over drug policies.

The megastructure will also determine which medications would be paid for entirely or partially by NZOK.

The Agency would replace and combine the current Drug Executive Agency and several other bodies at the Health Ministry. It would issue permits for the manufacturing, import, retail, wholesale of medications, conducting of clinical tests and others. The Commission would further assess the quality, effectiveness and safety of medicinal drugs and allow or ban their use.

The new body would also coordinate investment projects for the building of new facilities for drug manufacturing or for renovations of old ones.

Sofia Opens Dyslexia and Autism Treatment Institute

At the end of June, a new institute for treating children suffering from dyslexia and autism opened doors in Sofia.

Seven specialists will be working with the children, including teachers, speech-therapists, clinic psychologists, children neurologist and a psychiatrist. They will also train parents, teachers and pedagogic consultants how to work with kids suffering from dyslexia and autism.

The next step for the newly opened institute will be to provide training for GPs and pediatrics.

National SPA Conference Focuses on Inflammatory Disease Treatment

Bulgaria's fifth National Spa conference "Rehabilitation, Balneotherapy, Cosmetics"opened on April 8, to focus on problems with degenerative and inflammatory diseases, strain of the limbs, various defects of the spine, organizers announced.

The conference took place at "Helios Spa & Resort" hotel in the Black Sea Golden Sands resort with large international presence. Guest speakers included Dr. Wolfgang Ortner and Dr. Kurt Sklarski from Austria, Dr. Petya Pieler from Germany and Mark Rodgers from the United States.

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