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Nikoleta Grigorova. Reimbursement Mechanism in Bulgaria. The perfect storm is everywhere. Changing environment. Heavy administration. Delayed Access. Patients. Lack of Transparency. Low awareness. Low budgets/ High copayment. The perfect storm – BG edition!.

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Nikoleta grigorova l.jpg

Nikoleta Grigorova

Reimbursement Mechanism in Bulgaria


The perfect storm is everywhere l.jpg
The perfect storm is everywhere

Changing environment

Heavy administration

Delayed Access

Patients

Lack of Transparency

Low awareness

Low budgets/ High copayment


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The perfect storm – BG edition!

  • fragmented in separated organizations and diseases;

  • making spontaneous actions preceding the dialog with the institutions;

  • ignorance of the legislation;

  • lack of national representation (necessary for inclusion in the decision making).


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The perfect storm – BG edition!

  • In the 2004 year, the first patient’s umbrella “Confederation of Health Protection” was created;

  • In the year 2010 the new Government administration confirms the national representation;

  • All members of the Confederation were involved in the process of reimbursement;

  • Adoption of new reimbursement regulation was made for new position of PA with new controlling function, for to being legal.


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Reimbursement process

Step 4

230 – 620 days

Pricing & Reimbursement

60-90 days

Reimbursement list

NHIF

Step 3

120-480 days

Positive Drug List (PDL)

PDLC /Council of Ministers (CM)

Step 2

  • NHIF Commissions + experts – physicians

  • Percentage based reimbursement

  • New reimbursement criteria for the first time stipulated in

  • Regulation

50 days

Price-MoH

Step 1

  • Drugs covered by public funding (NHIF, MOH, hospitals)

  • Prepared by PDL Commission – MOH, CM

  • Appeal procedure at MOH

  • Adopted with ordinance of the Council of Ministers

210 days

MA

Drug Agency

  • Lowest price in

  • the Council of Europe


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Institutions involved in reimbursement

MoH – the national health policy maker

Priorities in expensive drugs for oncology and hemodialysis

The solely European country, which makes not only general health policy, but lead tenders for expensive drugs

Working on the Positive Drug List Committee

NHIF – monopolistic payer in the primary care

Heavy administration of reimbursement

Monopolist on the market

Constant budget deficit, no effective controlling mechanism

Current problems with the hospital funding

Reimbursement in %



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NGOs

Member of Coalition in the controlling Board of NHIF (Association of Bulgarians with Bronchial Asthma)

Member of Coalition in the Transparency Commission (supervise the decisions of the Positive Drug list)

Member of Coalition in Audit Committee to Regulation 34 to the Ministry of health

Member of Coalition - observer to the weekly sessions of the Health Committee to the Parliament

Member of CHP in Audit Committee to Regulation for expensive drugs to the Ministry of health


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Copayment in % of “patient’s pocket” for

drugs in relation with reimbursedones in EU


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