Under pressure from protesting people with severe health disabilities, Prime Minister Boyko Borissov has resorted to his usual approach – halting another unpopular health reform and leaving the sector without alternative solutions. Krassen Nikolov has the story.
Krassen Nikolov is a journalist specialised in judiciary affairs. He works for Mediapool and is a regular contributor for BulgarianPresidency.eu for the six months of the Bulgarian Presidency of the Council of the EU.
Last week the Ministry of Health published changes in the ordinance on medical expertise. The reform affects the rules for special medical committees that certify people with health disabilities. Experts have warned that half of the people now receiving a disability pension may lose it under the new rules.
According to official data, 500,000 Bulgarians currently receive a basic disability pension, and another 400,000 people take extra money to their basic income because of their illnesses. This represents nearly 14% of all Bulgarians. Though modest in size, these pensions cost the budget €850 million a year, which is 7% of all state spending. Experts have warned that the changes would affect half of people with disability pensions, and this creates a huge political problem for the ruling party. At the last elections about 1 million people voted for GERB, a number approximately equal to that of people who receive pensions for their health status.
The reform foresees that illness does not automatically lead to social benefits. The purpose is to judge whether the patient can work or not. This leads to the first problem – patients will pass a test through two committees, not one, as it is now.
The second problem is the possible reduction in the number of pensions. The idea is for doctors to make their judgment on the patient’s main disease rather than to accept all their health issues as qualifying for a pension status. The Ministry of Health believes that this will eliminate the subjectivism of doctors.
Former Health Minister Miroslav Nenkov describes the situation as follows: “With the appropriate committee I could qualify for over 50% reduced working capacity – I am fat, I have high blood pressure, I will say may back hurts and I will never be fired from work “.
Health Minister Kiril Ananiev insists making the point that the reform is being proposed by the medical guild and national health consultants.
The situation with disability pensions really needs urgent reform, and some of the nationalists in the ruling coalition also call for drastic cuts in spending. Every year between 40,000 and 50,000 new patients are able to obtain social benefits due to health disabilities. There are suspicions that some of these decisions are the result of corrupt practices in medical committees, so it is expected that the new rules would tighten controls because of clearer assessment criteria.
But Prime Minister Borissov is not so sure because he can end up the loser of the reform. Besides, he has the habit of withdrawing proposals his own government has made, when he senses popular discontent.
Physicians in special committees and people with disabilities suspect that the changes only aim at reducing budget spending, and not creating a fairer system. Experts are also giving brutal examples of individual cases. A patient with a severe psychiatric condition (schizophrenia) who during a crisis has jumped from a high place and injured his spine has a right to a full disability pension and social care. After the reform, his pension could be reduced because his spinal problem would not be considered a leading illness. For this man this is his only income.
The leader of the Podkrepa trade union Dimitar Manolov called the prepared reform an outrage and compared it with Hitler’s policy.
“There was one man in Germany (Hitler) between 1932 and 1945, who imagined the solution to the question in similar terms. According to the words of another man in the East (Stalin), “There is a man – there is a problem, there is no man – there is no problem”, Manolov said in a speech to organizations of people with disabilities who applauded him strongly.
Social Minister Bisser Petkov tried to calm down the situation with the assurance that the state will continue to provide €850 million. He commented that the goal is to spend most money on patients who really need state support.
According to present rules people entitled to a disability pension are tested at least once every three years. If the reform is implemented, they will be judged on the new criteria and at least half of them will receive less money. For some patients, pensions will be suspended altogether, experts warn.
The proposed reform would indeed reduce the number of people with disability pensions, but at the same time would make medical committees much more flexible. There will be an opportunity to open medical commissions in small towns, which makes the procedure more accessible. There will be a possibility of assessing diseases only by document, not necessarily by clinical examination, which is a major problem for some of the people with mobility difficulties.
However, because of the certain political losses, Borissov decided to stop the reform even before the public discussion ended. He was in a hurry because a protest of people with disabilities was scheduled on 11 April before the Council of Ministers for people with disabilities, which would paint a dramatic picture of the ruling party. So the protest was canceled. Borissov’s hesitations are likely to discourage Health Minister Kiril Ananiev to fulfill his promise and by the end of the year to offer a completely new health model in the country.