Bulgarian National Report, May 2017


As you may know, for Bulgaria the period since our last meeting in Bucharest in October has been marked by a government crisis, as the government resigned right after the presidential elections in November 2016. Most of that time, the country has been managed by a caretaker cabinet appointed by the President on 25th January 2017, which is not entitled to legislative changes as they are the prerogative of the Parliament.

The analysis of problems related to BMA non-signing of the 2016 National Framework Agreement (2016 NFA) was further developed by processing and submitting to the Ministry of Health of proposals made by the BMA Specialty Boards, medical facilities and physicians from all over the country, for amendments in the Ordinance on the Basic Package of Health Activities Ensured by the Budget of NHIF (National Health Insurance Fund) and in the Ordinance on Preventive Examinations and Dispensarisation. BMA also developed its own draft of the law on the 2017 NHIF (National Healthcare Insurance Fund) Budget as well as a number of BMA drafts with legislative amendments in the Health Insurance Act (HIA) and the Act on the Health Establishments (AHE) which were presented before the Parliamentary Groupings in the 43rd Parliament and the respective Committees on Healthcare, Budget and Finances.

The BMA Managing Board proposed amendments to HIA regarding the introduction of an additional package which should be ensured by a second pillar of funding while all the mandatory health insurance contributions remain for the basic package.
On the occasion of the FEMS Initiative – 24th October – European Doctors’ Action Day, BMA organized a National Round Table on Healthcare Funding issues in the country. We should definitely mention also the national discussion on the topic “How much does labour of medical specialists cost?” organized by BMA approximately six months later where a Methodology for Determining of Weighting Coefficients for the Medical Activities (developed by the BMA) was presented aiming to give impetus to practical obliteration of disparities in the pay of medical specialists in different specialties and fields. These forums were very well prepared and supported with the presence of members of the Parliament, patient organizations, Doctor’s associations and trade unions.

A major step in the field of Emergency Medicine was the adopted Emergency Care Concept as well as the National Emergency Medicine Standard notwithstanding that the part of the latter concerning hospitals was appealed to the Supreme Court of Appeal (SCA) and subsequently repealed through a Court Decision.

Following the introduction of the National Health Map, in its contracts with the medical facilities the NHIF set limits on the beds in the hospital wards.

Meanwhile, a case for repealing the fingerprint authenticator was filed to SCA. So, in compliance with the decision of the court, the acting Minister of Health ordered its revocation.
In this setting, BMA held negotiations with NHIF to sign a new framework agreement on the terms and conditions of practicing medical activity in Bulgaria. By a decision of the Supreme Forum of the Medical Association, 66th Extraordinary Congress (Convention), held in February 2017, BMA endorsed signing of the 2017 NFA (National Framework Agreement) thus eliminating the possibility for the NHIF Supervisory Council to change the NFA regulations unilaterally by decisions.
In the 2017 NFA, we achieved a number of sought changes, the most important of which are, as follows:
• Collaborative drafting of guidelines and other acts on interpretation of the NFA;
• The methodology of comprehensive quality assessment shall be drafted jointly;
• If possible, an electronic recipe could be issued;
• Clear definition and introduction of rules on for the allocation of funds to primary and specialist outpatient and inpatient care facilities;
• Non-admission of funds transfers from one paragraph into another; in case of objective emergency, this could be implemented only after a negotiation process between the BMA and the NHIF.

The newly adopted electronic system in the Doctors’ Register facilitates and relieves the administrative burden on the Association members, by optimizing the processes of registration, enlisting and moving between the Regional Associations and minimizing issuance of paper documents thus contributing to the development of a modern electronic professional dossier for each physician. All the Certificates generated by the Register are already equipped with unique anti-manipulation and cross-checking code.
The BMA website was modernized while another novelty is dissemination of information about the Association’s activity through a newly established Facebook account.

The Management of the professional organization undertakes a number of actions to retain the doctors in the country in order to heighten their motivation to stay and work here. For a fifth consecutive year, BMA grants scholarships to young doctors-in-training and postgraduates. In the first year since the launch of the project to support the young doctors, the scholarships awarded were only 11 while this year BMA managed to raise funds for 56 scholarships.

BMA organized and held the Third Scientific and Practical Conference in April 2017 which was attended by more than 300 physicians.