If public healthcare in Bulgaria had a face, it could well be the crumbling facade of the public hospital in Lovech, brought to the edge of bankruptcy by a controversial contract with a private sector clinic.
Weary-looking doctors and medical workers have been protesting outside the hospital — situated in one of the poorest regions of the EU’s poorest country — to demand their delayed salaries.
Earlier in May they blocked the road to the hospital in the north-central city for days on end, shouting: “We are hungry!”.
Lovech’s hospital is a victim of a controversial use of the public healthcare system now being investigated with private clinics installed inside public hospitals, amounting to “hospitals within hospitals” like Russian dolls.
For over 10 years, Lovech was host to a private cardiac surgery clinic which detractors say drained vital resources from the public health fund and left the hospital on the brink of ruin.
“They only did the most expensive surgeries that are reimbursed in full by the fund,” nurse Nevyana Borisova told AFP.
“But the patients were prepared for the surgery in our hospital, which also takes care of them afterwards. They made the profit and we got the costs,” she explains.
Anaesthetist and local trade union leader Sevda Kulinska says that as more and more money went into the clinic run by the Cardiolife company, other units in the hospital suffered severe underfunding and four of them had to close.
– Corruption or mismanagement? –
Under Bulgarian law, using private operators in public health provision is allowed but is meant to add services not already being offered by the public system.
According to chief prosecutor Sotir Tsatsarov, this mechanism has been misused and turned into “one of the main instruments for the misappropriation of public health funds.”
In the case of Lovech, Cardiolife recently moved out of the hospital and its management denies any wrongdoing.
“The regional hospital fell victim to flaws in its own management: the personnel is ageing and there is a lack of initiative,” Cardiolife chief accountant Iliana Kostova told AFP.
Nevertheless prosecutors are investigating the contract in Lovech to see whether any corrupt practices were involved in the way it was awarded, including on the part of the ex-director of the local health fund, who has since become a partner in a new Cardiolife clinic.
Prosecutors are combing through contracts signed by all 195 public hospitals, and say they have found even more extreme examples of funds being diverted by similar “hospitals within hospitals”.
“At least 13 hospitals were found to be on the brink of bankruptcy, while the private entities inside them prospered,” said prosecution spokeswoman Rumyana Arnaudova.
Among the numerous other examples is a hospital in the northern town of Vratsa which paid millions to a private hospital 300 kilometres (186 miles) away which was meant to send consultants who allegedly never showed up.
Bulgaria’s centre-right government has even had to extend emergency financial aid to cover months of delayed salaries for staff in the hospitals in Lovech and Vratsa.
– ‘Who will work here?’ –
However, Atanas Atanasov, head of another hospital in the eastern town of Shumen, points out that corruption is just one reason “why the public healthcare system is headed towards catastrophe”, adding that severe underfunding has to be taken into account too.
Some 12 percent of Bulgaria’s population lack health insurance. Low incomes also shrink the revenue base for public health funds.
Bulgaria spends half of the European average on healthcare, according to a recent report by the European Commission.
It found that as a result, Bulgarians have the EU’s highest out-of-pocket expenditures for healthcare — as much as 48 percent compared to an EU average of about 15 percent.
Bulgarians’ life expectancy of 74.7 years is also the second lowest in the European Union, the report added.
All this is compounded by the persistent emigration of healthcare staff.
According to their trade union, some 30,000 nurses have left Bulgaria over the past 10 years, mostly for Germany and the UK, where they can earn up to ten times as much as at home.
“The doctors who remain here are all nearing retirement age. Who will work after them?”, a Sofia oncologist asks.
Indeed, most of the doctors and nurses protesting back in Lovech told AFP that they had worked there all their lives and had only a few years left until retirement.