Negotiations between the National Health Insurance fund (NHIF) and the Union of Physicians on the basic benefit package failed in 2012 resulting in a refusal of the Union to sign the National Framework Contract (NFC) for 2013. As a result the government initiated changes in the Health Insurance Law in order to allow the NHIF to extend the basic benefit package without the Union’s approval.
Compulsory vaccination (immunization and re-immunization), in-vitro procedures, intensive care and ambulatory care for mentally ill patients and patients with dermato-venerological diseases were financed by the state trough the Ministry of Health (MoH) budget before 2013. In 2013 this changed and these services were covered by the NHIF. Transfers from the MoH budget to the NHIF budget were envisaged for providing these services to uninsured people. Only access to in-vitro procedures for uninsured people was restricted in 2013. Because of this, compulsory vaccinations and in-vitro procedures will be shifted again from the NHIF basic benefit package to the Ministry of Health budget in 2014, after amendments of the laws on health and health insurance. In 2014, the NHIF will continue to pay for the in-vitro procedures started in 2013. All new procedures will be funded by the Center for Assisted Reproduction through the MoH budget as it used to be prior to 2013.
Intensive care, however, is still covered by the NHIF in 2014 and financing is likely to remain problematic. Prior to 2013 – when intensive care was financed by the MoH – per diem rates were BGN 300 (€153.3) or BGN 500 (€ 255.5), depending on the hospital’s level of competency. In 2012, a total of BGN 60 million (€30.7 million) of the MoH budget was allocated to intensive care of insured as well as uninsured patients. In the NHIF budget for 2013, BGN 40 million (€20.4 million) were envisaged for intensive care, which decreased the per-diem rates substantially. As a result, hospitals were faced with significant losses for treating uninsured patients or patients not admitted on a clinical pathway to the intensive care units. The insufficient financial recourses for intensive care envisaged in the NHIF budget for 2013 were one of the main reasons for the refusal of the Physician Union’s to sign the NFC for 2013. Intensive care will be funded by the NHIF with BGN 42 million (€21.5 million) in 2014.