Ombudsperson submits critical opinion on draft budget of national health fund

Bulgaria’s national Ombudsperson, Maya Manolova, submitted a critical opinion to Parliament on the budget bill of the National Health Insurance Fund (NHIF) for 2019, the Ombudsperson’s press office announced on 29th of October.

She underlines that the Draft Law on 2019 State Budget repeats the structure of the budgets of the past decade, with prevauilance on the cost of hospital care and medicines again, even though the Health Minister himself has repeatedly pointed out that this disproportion should be corrected and support outpatient medical care.

In the adopted budgets, the vicious practice of limiting activities of doctors, which, as repeatedly pointed out in the opinion of the National Ombudsperson and by most experts, has a very negative impact on patients because it makes their access difficult, restricts the right of choice of where to get treatment and in the long run leads to a decrease in the quality of medical care due to the worsened competitive environment.

Maya Manolova draws attention to the fact that the NHIF budget law turns the Council of Ministers and the National Assembly into subsidiary bodies of the new Medical Surveillance Agency regarding the licensing of new hospitals or new compartments in existing ones. The Ombudsman understands how ministers have supported a project that obliges them to agree or refuse to open, for example, a department of urology, orthopedics or eye diseases in any one of the country's hospitals.

According to her, the project introduces serious structural changes - acting bodies get closed down and new ones are set up, such as with the Medical Oversight Agency, this leads to the mixing of functions in a body that is left out of all forms of civil control. This creates conditions for abuse of rights.

Manolova identifies as extremely worrying the changes in the treatment of patients introducing the principle of prescribing medicinal products based on a therapeutic course that is consistent with its cost-effectiveness. The Ombudsperson is firmly convinced that this limits the right of citizens to individual treatment consistent with their condition and the judgment of treating doctors.

Maya Manolova stresses that the draft law on the budget introduces important amendments to a number of laws, which in most cases have no direct connection with the NHIF budget for 2019 and are not related to its implementation.

In addition, the Law on the Normative Acts provides for the preparation of a new normative act to conduct public consultations with citizens and legal entities, at least 30 days prior to its submission. Such public consultations have not been carried out.

In conclusion, the Ombudsperson proposes to the Parliament to discuss the proposed bill in its section on the budget of NHIF for 2019 and to consider all other proposals for amendments to other laws separately, according to the procedure provided for in the Constitution and the law requirements, after making the preliminary assessments and public discussion.