3 min.

Commentary: Do we treat the health insurance fund or the patients?

Stela Stoyanova |

Commentary: Do we treat the health insurance fund or the patients?

A possible decision to pay only for the cheapest medicines sounds scary

Bulgarian parliament voted Dr. Decho Dechev (a former head of one of Sofia's best managed hospitals) to become the new director of the National health Insurance Fund (NHIF). His first moves, as he announced them in the first days after the appointment were in both directions – to cure the constant deficit funding of the NHIF and to secure that only the cheapest (if possible) medicinal drugs prescribed by doctors are the ones that the health insurance fund reimburses to patients...

After hearing the first proposals by Dr. Decho Dechev we were left with the impression that one of the first order of business of the new NHIF head would be to deal with prescription drugs. It is true that he inherits a list of problems that have been amassed for many years and that he is struggling to deal with as soon as possible. The one of its kind reform in Bulgaria's health system, it is obvious, would again be in detriment to patients.

"All over the world, pharmaceutical industry encourages the prescribing of more expensive drugs and therapies. This is not in the interest of the patient and must be changed," Dechev said yesterday. However, if the NHIF decides to support only the cheapest and popular medicines, and all other are left for the patients to pay entirely, this will make practically impossible the access to hundreds of drugs that are the most proper for sick people.

We all know that generic drugs, which are cheaper and therefore reimbursed by the NHIF,

have a considerably weaker effect, and sometimes no effect on illnesses.
In such a case, patients are forced to pay the entire sum of money for the more expensive and certain to help medicine, and the health insurance fund will have not contribution at all. At least two friends of mine that suffer from Parkinson's disease used to be prescribed a drug, reimbursed by the NHIF, which was not helping at all, and therefore had to spend their own money to pay the better ones in full.

We have also had the opposite cases – I know people that have applied for reimbursement by the NHIF for some of the possibly most expensive drugs that are not good for their disease and move to cheaper ones later. It is the doctors who know best that the decision which medicines to prescribe to the patient, especially in cases of serious illness stage, is on case-by-case basis. So, we cannot sell the most popular and cheapest drugs for tough diseases.
The world now moves to the so-called personalised healthcare, where an individual drug is chosen for each patient according to their test results.

In Bulgaria however, we try to stuff them in the mould of mass measures,

because all we care about are financial results. Then, who do we treat – patients or the problems of the health insurance fund, the latter being proven a long time ago? At this stage all measures are just intended to fit to the rules of the NHIF – clinical pathways, recipes, and all drugs prescribed according to the mould. Meanwhile, people go and pray to chemo therapists and healers, cancer patients buy healing mushrooms from China on the internet and die in two-weeks' time. Bulgarian doctors now wonder not how to treat the patient but how to include them in the clinical pathway. I have witnessed this with relatives of mine that are admitted to hospital with one diagnosis and leave it with another one. And many doctors, in their desire to stick to the rules of the NHIF, have turned into magicians, pulling out rabbits from their sleeves to help their hospital implement the budget.

My hope is that Dr. Dechev will not make fools out of them, as well as with patients, the latter mostly paying additionally in order to obtain medicines that are proper for their individual needs. However, may we first have to treat the health insurance fund?

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