On Friday, 13 September, the Supreme Administrative Court finally suspended all financial limits on treatment for Bulgarian patients. This will increase the budget deficit faced by the National Health Insurance Fund (NHIF) which is now obliged to pay hospitals even if treatment costs exceed the set volume limit.
As reported by Krassen Nikolov of Euractiv in their news, on 13 September 2024, the Supreme Administrative Court suspended all financial limits on treatment for Bulgarian patients. Until 2024, Bulgarian hospitals could not spend more than the precise amount set by the state to treat specific diseases. “When the mechanism of prior limitation is abolished, the National Health Insurance Fund will pay for the activity performed and reported by the medical institution,” the Supreme Court said in its decision.
The decision followed a Constitutional Court ruling in April, declaring that the financial limits are unconstitutional and that the National Health Insurance Fund (NHIF) is obliged to pay hospitals if treatment costs exceed the limit. “The financial limits on hospitals violate patients’ right to affordable medical care,” the Constitutional Court said.
These two key decisions by Bulgarian courts “have altered the hospital finance model, abolishing strict limits on care volume amid a growing budget deficit” reported Euractiv:
Since the Constitutional Court’s decision in April, the state health insurance fund has been forced to pay hospitals much larger sums than the healthcare budget approved by the Bulgarian Parliament.
The national health budget for 2024 provides €1.8 billion to fund the country’s hospitals. Now, the deficit is expected to be much larger. The government spends around 4% of GDP on healthcare (€4.1bn) each year, with nearly half the money going to hospitals. This financial framework has proved insufficient over the years as private spending is about the same amount.
Lawsuits are continually being brought against the NHIF as the hospitals are trying to get reimbursed for extra costs incurred when the limits were in force.
The State Health Insurance Fund announced that changes to the Health Insurance Act should be made to improve the collection of citizens’ health contributions and strengthen the sustainability of the health system’s budget for 2025.
Euractiv also reported that Bulgaria was trying save hospitals from bankruptcy with investment loans. Hospital dept crisis led to a situation when one hospital could not pay the salary of its specialist staff for seven months. The solution offered by the Bulgarian Development Bank (BDB), provides preferential loans of up to €2.5m to cover liquidity needs and to finance investments in infrastructure and equipment. The aim is to improve healthcare and the financial stability of healthcare institutions. A loan of up to EUR 2.5 million is available to all state and municipal hospitals that implement the state’s Healthcare Restructuring and Sustainable Development Plan. “In this way, the bank will reduce the level of indebtedness in the system and encourage it to manage and control cash flows more effectively,” the Bulgarian Development Bank told Euractiv Bulgaria. The Ministry of Health reported that in 2023, eight out of 61 state hospitals took out loans from banks worth more than 40 million euros to repay their arrears. Bulgarian hospitals also have access to nearly €273 million from the EU Regional Development Programme.
