MR IVAILLO CALFIN
DEPUTY MINISTER - CHAIRMAN
ON DEMOGRAPHIC AND SOCIAL POLICY
MINISTER OF LABOR AND SOCIAL POLICY
AND CHAIRMAN OF
THE NATIONAL COUNCIL FOR TRILATERAL COOPERATION
REGARDING: Bill for Amendment and Supplement to the Law on Medical Facilities, No. 502-01-47, submitted by the Council of Ministers on 9.06.2015/XNUMX/XNUMX.
DEAR MR CALFIN,
KRIB supports the adoption of such decisions that will lead to the introduction and confirmation of practices guaranteeing the quality and efficiency of the health care system, but at the same time representing an adequate solution for the local market, in the conditions of the competitive environment of the common European market. We believe that Bulgarian business can provide the state and other partners in the healthcare system with an economically justified approach and vision for development and change.
The Confederation of Employers and Industrialists in Bulgaria in principle supports the changes laid down in the draft law amending and supplementing the Law on Medical Institutions, but we have the following comments and suggestions:
I. According to § 26. The approval of a National Health Card should be done by an act of the Council of Ministers, as it is important for the national security of the country. The composition of the national commission should also include representatives of the MoF, MO and MIA. The rules by which the commission will work should be regulated by a by-law, and not by an order of the minister, who is also its chairman.
II. According to §27.
It is proposed to create a third sentence in Article 34, paragraph 2:
"Cases in which there is a need for a partial update of the National Health Card shall be determined using a methodology approved by the Minister of Health."
The national health card affects the interests of the entire society, the procedure for its creation needs a permanent settlement, which is why the cases of updating must be settled in the law, and not in a methodology that does not have the nature of a normative act.
2. In Article 34, it is proposed to delete Paragraph 3, which stipulates that the preparation and updating of the National Health Card shall take into account the compliance with the requirements under Article 19, para. 2 and 3 of the same law of the respective medical facilities. Pursuant to Art. 19, para. 2 and para. 3 of the Health Care Act, the medical facility for hospital care carries out its activities:
1. in accordance with the approved pursuant to Art. 6, para. 1 medical standards and the rules of good medical practice;
2. if the medical facility is insured for hospital care with medical specialists on a basic employment contract;
3. in the presence of the medical standards defined in Art. 6, para. 1 technically serviceable medical equipment and equipment on the territory of the relevant medical facility, as well as should ensure a continuous 24-hour performance of the medical activity in medical specialties, according to the permit issued to him, including medical assistance in emergency situations.
It is not clear what necessitates the cancellation of this text from the law.
III. According to §30. With the new art. 37a provides that the National Commission, which prepared the NHIC, will assess the needs of hospital medical care for new medical facilities that want to obtain permission to carry out medical activities, and if there is an excess of needs with the new medical facilities for hospital care, the NHIC will not conclude contracts. The law does not provide an order for assessing the needs of medical assistance in relation to medical facilities for outpatient medical assistance, in the areas where there is an excess. Does this mean that every new registered treatment facility for outpatient care will be able to enter into a contract with the NHIF.
The proposed bill does not provide an answer to the question of how contracts will be concluded by the NHIF in areas where there is already an excess of needs for outpatient and inpatient medical care from existing medical facilities.
The law does not regulate the procedure by which the commission under Art. 33 makes its decisions and there is no foreseen procedure for judicial appeal of the assessment under Art. 37a. The lack of clear legal rules can create conditions for additional corruption in healthcare, which is still high today.
IV. We propose in Art. 86, the words "subject to voluntary accreditation" should be replaced by "obligatory accreditation".
V. under §52. In the new paragraph 3, we propose to replace the words "according to paragraph 2" with "on the proposal of the Minister of Health".
The rector of the relevant higher medical school, in agreement with the head of the medical institution, may not make a request to revoke the status of a university hospital, even though the term of the accreditation assessment has expired.
VI. According to §54. With the new paragraph 3 of Art. 95, medical facilities are created
to create associations under Chapter Eighteen, Section I of the Commercial Law for the purpose of concluding a contract for the provision of medical assistance under Art. 20, para. 1, item 4 of the Health Insurance Act. With this provision, in practice, it is possible to circumvent the prohibition under the new Art. 37a, para. 8 for medical facilities. We offer the following version of paragraph 3:
"3. to create associations under Chapter Eighteen, Section I of the Commercial Law for the purpose of concluding a contract for the provision of medical assistance under Art. 20, para. 1, item 4 of the Health Insurance Act. Associations cannot include medical institutions that have received a negative opinion under Art. 37a. "
VII. Regarding Art. 17, para. 2; Art. 47, para. 1, item 3; Art. 63, para. 1 and Art. 65, para. 1
We believe that the requirement that managers /executive directors/ of medical institutions possess qualifications in health management, and in the case of masters in economics - a recognized specialty in medical informatics and health management or in health care economics, should not be dropped.
Our reasons for this are the following: The disciplines studied in these specialties provide a high degree of professionalism. Such training certainly contributes to the efficient and adequate management of limited resources in health care. One of the problems of the health care system in Bulgaria is that currently nearly 80% of the managers of medical facilities in our country do not have the necessary knowledge and skills to deal with the challenges of the health services market.
In addition to the above, we believe that the training of students in these specialties is aimed at them acquiring not only theoretical knowledge, but also practical skills necessary for competently developing and solving managerial, organizational and health-political problems in the health care system. The final product of the training should ensure the formation of a new generation of innovative and competent health managers meeting European standards.
In this sense, we consider that the proposed changes in Art. 17, para. 2; Art. 47, para. 1, item 3; Art. 63, para. 1 and Art. 65, para. 1, in the draft of the ZID of the ZLZ will actually give a wider range of persons the opportunity to occupy the positions of manager and executive director of a medical facility, but do not guarantee their skills to carry out in-depth health-political, socio-medical and economic analyzes and assessments , necessary for making adequate management decisions in health care. For the above reason, we believe that the additional qualification and specialization in Health Management and Health Economics is mandatory, as with other majors.
With regard to the texts in the draft of the ZID of ZLZ, concerning the privatization model of medical facilities offered at this stage, our opinion is that the hospitals - the backbone of health care / regional hospitals, university hospitals, specialized children's hospitals, cancer hospitals, medical facilities for lung diseases and etc./ must remain on the prohibition list for privatization
We hope that our proposals on the ZID of the PHI will be taken into account during the further consideration of the Bill.
With respect,
Eugene Ivanov
Ex. director
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