For good private hospitals, public policy is always a priority

“For us, the patient always comes first” – with this understanding in the heart and soul, and in deed, the Bulgarian Cardiology Institute (BCI) established the first specialized cardiology hospital in 2007 in Pleven. To date, it has seen hundreds of thousands of satisfied patients and saved tens of thousands of lives in life-threatening cardiovascular diseases and events, mainly myocardial infarction.

What is the top priority of government health policy in Bulgaria?

There is no single political or legal definition. It undoubtedly includes the provision of accessible and quality medical care, treatment and health services for the entire population of the country. In the leading modern ‘Heart and Brain’ hospitals and the brilliant newly built ‘Mom and Me’ clinic, patients young and old from all over the country and from all countries in the Balkans, from absolutely all age groups, from absolutely all ethnicities, including people from Africa and Asia, are treated. “We have never ‘selected’ patients to be hospitalized, neither by ability to pay, nor by any other criterion, such as financial or educational background, ethnicity, origin, etc., but only by medical indicators and indications, and we practice evidence-based medicine” – firmly states Prof. Dr. Iana Simova, Executive Director of BCI.

Private hospitals do not receive government subsidies and capital injections

So how do they manage so that they are not, as the minister puts it, “ticking bombs”, but rather should be and are like “ticking clocks”? False accusations of patient selection or of not accepting the most serious cases collapsed quickly this year when the NHF announced that 24% of major cardiac surgery (in 100% acute life-threatening conditions) in 2022 was carried out in ‘Heart and Brain’, and with a record low in-hospital mortality rate for the whole of Europe. Over 60% of all cardiac surgery interventions and invasive cardiac procedures are performed in private hospitals with – by common admission – very good clinical outcomes. Serious private hospitals have opened their own pathology departments, laboratories and other units with low or no profitability.

Emergency care is state-run by law and physically located more often in government hospitals

This continued monopoly, for which there is no clinical pathway and is fully funded by the state budget, distorts the picture of private hospitals’ contribution, creates conditions for the feudal influence of individual state directors and, worst of all, suppresses patient choice. One glaring example of feudalisation in Pleven: the state emergency is located in the state hospital building. The director of the state hospital has banned and, after a series of scandals with the changed director of the emergency, has managed to restrict the referral (sending) of emergency patients to private hospitals in the city and especially to Heart and Brain. Although there is full preparedness and excellent facilities for providing state-of-the-art emergency care, a number of patients are forcibly taken to their non-preferred government hospital – against their will and the will of their relatives. Rough administration of the process violates the patient’s right to choice and lowers the quality of hospital healthcare in the country, which certainly remains a top government priority. And the public function that a doctor performs – whether his employer is public, municipal or private – is the same. For example, whenever a Bulgarian court has appointed a doctor as an expert from a private hospital in a court case, he has always responded and given his objective professional expertise.

The Minister has repeatedly reaffirmed his correct understanding that it is only through the joint and coordinated efforts of private and public hospitals, including mergers, privatisation or other organisational forms of cooperation, and only through competition on quality, that we can raise national healthcare to a European level.