Health insurance – a balance between responsibilities and rights

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The creation of a second pillar through universal health insurance companies will transform the system into a solidarity-capital

The Minister of Health Desislava Atanasova announced that she is waiting for proposals for solving the problem with the huge number of uninsured Bulgarians . She explained that she would ask for specific proposals from the management of the health insurance fund and the revenue agency, as well as from the professional and patient organizations that are related to these revenues.

However, in addition to the institutions, we decided to seek the opinion of the ordinary citizen – whether he conscientiously pays his contributions or boycotts the system. What to do to solve the problem – we are waiting for your ideas at [email protected]!

Today we present the position of Stefan Assenov *.


The current legislation on health insurance in Bulgaria started in 1998 with the adoption of the National Health Strategy. On its basis in the same year, the National Health Insurance Fund / NHIF / was established. With its appearance, the funding is distributed between the republican budget and it.

Health reforms continued in 1998 with the adoption of the Health Insurance Act. It regulates two types of insurance – compulsory / first pillar / and voluntary / third pillar /.

Through the obligatory social health insurance / Bismarck’s model / every Bulgarian citizen is obliged to participate with monthly obligatory contributions to it. Until 1998 it was 6%, and since 1999 it has been increased to 8%.

This model relies on equality and solidarity in the use of medical care in Bulgaria.

The idea of ​​the legislator is for the NHIF to be an independent state body that provides access to health insured persons to medical care and activities based on the right to free choice of who to provide it / as long as there is a contract with its regional unit /.

The application of the principle of solidarity of the insured in the use of the raised funds harms entire groups of citizens. This principle was adopted by modern societies on the day when they found that simply abandoning the weak (sick) in the social sense leads mainly to negatives for the whole society.

I will give the following example: you deposit over the years 1000 monetary units / which go to a general account – cash register /, but you do not have to use them/you use 0 units /. At the same time, someone who has imported 100 units or someone uninsured needs medical care of great value. They have not paid enough (or not at all) to cover the costs of their treatment. But they are treated on the basis of the solidarity model just as much as you, who have imported 1000 units if you need.

It is also a fact that some of the expensive pathways (especially in cardiology, emergency care, traumatology, etc.) are underfunded. In these cases, the insured person has to pay extra if he wants to be treated in the best way. The same applies to the choice of team / you pay if you want to be treated by a certain good specialist /. Not to mention that there are areas where there is a real lack of NHIF. One such example is psychiatry, where almost everything is paid for by the patient.

In other words, this model leads to distortions in the system and to the detriment of groups of citizens.

The solution would be to break the NHIF monopoly and create a second pillar for health insurance. These can be universal health insurance companies / similar to the pension system /, which after the last changes are now insurance companies. In this way, the system from pure solidarity will become solidarity-capital. This is the so-called a mix between state and liberal systems.

In this case, the health contribution is again transferred to the NSSI. But there are two options:

In the first option, part of it / for example 2% / NSSI transfers to the Universal Health Fund/insurance company licensed by the FSC /, pre-selected by the person.

In the second case, a mandatory additional health contribution is created / I suggest it to be around 2% /, which is again transferred to the National Social Security Institute. But this contribution must be paid 100% to the private company by the National Social Security Institute / unlike SMPS /.

In this way we will have three pillars of health insurance – NSSI / first solidarity /, private companies / second capital / and the third, which will be voluntary of capital type.

If this approach is adopted, the system will be balanced. The capital funds / private companies / will co-finance the system for: team selection, expensive interventions, better consumables, joints, medicines, etc.

* Stefan Assenov is an expert with over 15 years of experience in the capital markets. You can learn more about him in his personal blogWorks on the article: Andrey Lyubenov , editor Petar Neykov

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