Fines for low wages and a big cut in the salaries of medical staff will come into effect from June. This was agreed on Friday by the Bulgarian Medical Union (BLS) and the Supervisory Board of the National Health Insurance Fund (NHIF). Tomorrow, the Medical Union is expected to give a mandate for the signing of the annex to the National Framework Agreement (NFA), which will include the new sanctions, after which the document will be officially signed.
According to the project for an annex to the NRD, fines are provided for medical institutions that do not provide the minimum basic remuneration of BGN 1,500 for nurses and BGN 2,100 for doctors, stipulated in the Collective Labor Agreement (CLA). If a hospital does not fulfill its obligation to bring the salaries in line with the KTD norms, the Health Fund will impose a financial penalty in the amount of BGN 200 to BGN 500 for each individual case. For repeated violations, the fine is from BGN 500 to BGN 1,000 for each individual case. Sanctions are also foreseen in cases where the gap in the salaries of the staff of a hospital is too large. There is already a text in the NRD according to which the ratio between the maximum and minimum gross remuneration of medical specialists in hospitals cannot be more than 10 to 1, but so far there have been no sanctions for its non-fulfillment.
On Friday, the chairman of the BLS, Dr. Ivan Madzharov, announced that the latest proposal is that if the hospital has reached the salaries set in the KTD, then the ratio between the lowest and the highest salary should be 1 to 15, and this applies for physicians who are not clinic managers.
Due to objections from the Doctors’ Union, at today’s meeting with the National Health Insurance Fund, it was decided that the biomarkers for cancer patients will be paid for by the pharmaceutical industry this year, instead of from the Health Fund’s research budget. The adoption of biomarkers by the National Health Insurance Fund is a long-delayed measure awaited by patients, but surprisingly, a few days ago, it was objected to by the Physicians’ Union. According to the Medical Association, biomarkers should not be covered by the research budget, but by the drug pen.
The most important thing for patients is the planned easier access to research and diagnostics, Dr. Madzharov also said, and recalled that efforts are aimed at one-day procedures in hospitals and diagnostic-consultative centers, without requiring hospitalization of the patient. A 10-day hospital stay is planned for patients with a severe stroke, Dr. Madzharov also pointed out. So far this stay has been four days.
For hospitals, the most important thing is that the most energy-intensive activities have the highest prices, he added. We continue the policy with each subsequent year for better funding of intensive care, he added. Dr. Madzharov expressed hope that in time it will be possible to introduce the “Anesthesia” procedure for small, medium and large anesthesia, so that anesthesiologists will also know how much their work is worth. Now their work is paid for either by the intensive care units or by the price of the surgical clinic, which is not very fair, Dr. Madzharov pointed out.
We have reached a consensus so that real mechanisms for effective prevention will also work, said after the meeting Prof. Mihail Okoliyski, Chairman of the Supervisory Board of the NHIF and Deputy Minister of Health. In his words, patients will be provided with richer prevention, with more research, and doctors will be motivated with higher pay if they do more preventive examinations. Patients will be able to be examined with nuclear magnetic resonance when they need it and they will not have to wait for the Health Insurance Fund to allow them, Assoc. Prof. Okoliiski also pointed out.
Incentives are planned for hospital managers who reach the minimum levels according to KTD, which would increase the motivation for effective management hospital solutions, said Prof. Okoliiski. According to data from the Ministry of Health, more than 112 hospitals have reached the basic salary levels set in the KTD, and we expect more to increase, added Associate Professor Okoliiski.
The manager of the National Health Insurance Institute Stanimir Mihailov said that if changes to the CTD occur in the current deferral period, the remuneration levels of medical specialists will be adjusted to the new CTD. According to him, for the hospitals that are most worried about the sanctions, the NHIF has earmarked funds to increase the salary levels of medical specialists. The increase in the levels of clinical paths from March 1 will also bring them more income, Mihailov added, and assured that the National Health Insurance and the BLS have no differences in this matter.
Hospitals have been receiving support since September 1 last year, Mihailov pointed out, specifying that BGN 30 million was earmarked for regional hospitals. According to him, there are also BGN 30 million. for municipal hospitals.
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