Municipal health care is often criticized. The provision of hospital care in smaller municipalities and settlements is accompanied by diverse problems – from a lack of sufficient funds, equipment and medical staff to difficulties in managing and providing quality health services. Let's not forget the strong sense of ownership of the local public towards the presence of at least one - albeit not so good - hospital on the territory of the municipality or even in the settlement. And as is typical for municipal commercial companies, information on the activities of municipal hospitals, although public, is not actually easily accessible and difficult to collect for analysis. The difficulties in this case are even greater due to the specifics of their activity - provision of health services. Outside the structures of the Ministry of Health and the National Health Insurance Fund[1], municipalities do not collect enough information about their hospitals and very rarely analyze their activities in substance. These are the reasons why the FII collects information under the law on access to public information about municipal commercial companies, including municipal hospitals, and in the next few weeks the database with municipal enterprises and commercial companies will be shared for free use, analysis and comparisons. Healthcare is a key activity in the public sector. We are looking at the municipal medical facilities for hospital care, which are commercial companies with 100% participation of municipalities in their capital - just over 100 companies (out of a total of 341 medical facilities for hospital care in the state), among which there are multi-profile hospitals, specialized hospitals, complex oncology mental health centers and centers. Most of them were registered in the period 1999-2001. Usually a municipality fully owns the municipal hospital, and we have excluded from the analysis the participation of municipalities in the larger hospitals at the district level, which is often within a few percent of their capital. 78 municipalities own at least one hospital, and the capital municipality owns the largest number of hospitals of this type – 12. The review of the financial indicators of the municipal medical institutions shows that, contrary to the often shared opinions about their dire financial situation, the data show that only a quarter of them are at a loss in 2020 and 2021. The total amount of losses in 2021 is about BGN 3 million, and profits – BGN 16.8 million. What is behind this seemingly good financial situation: A large part of the municipal hospitals have found a balance between the services to provide to the population on clinical paths and the costs for them, and the amount of both profits and losses is relatively small - within a few thousand BGN. Whether cases of cherry picking are observed, we can only guess, although the financial model of hospital financing actually encourages such behavior. Such an analysis on the part of both the owners - ie. municipalities, as well as the NHIF, however, is not legal, or at least not publicly available. With the largest profit - over BGN 1 million for 2021 - "Knyaginya Klementina" MBAL - Sofia, KOC - Burgas and MBAL "Ivan Skenderov" - Gotse Delchev. The relatively weakest results are SBALO "St. Mina" - Blagoevgrad, KOTC - Veliko Tarnovo and MBAL Svoge. Of course, for a more in-depth assessment of the financial result and trends, a longer period needs to be considered. There are 13.6 thousand employed in municipal hospitals, or nearly a third of those employed in all municipal commercial companies. The average number of employees in a municipal hospital is 135 people. The assets of municipal hospitals are relatively limited and reach a total of BGN 388 million in 2021. Both years under review were marked by the covid-19 pandemic. It led to an increase in both revenues and costs of all medical institutions. In 2021, staff costs in municipal hospitals increased by 35% and total costs by 25% compared to the previous year. Revenues for the year increased by 22.5%. The brief presentation of the municipal medical facilities for hospital care shows that Bulgaria has a very large number of hospitals in small settlements - nearly a third of all hospitals in the country are of this type. At first glance, they work in the conditions of balance - on clinical paths that they can serve without serious financial difficulties. Assessment of the quality of health services based only on financial information cannot be done without a thorough analysis that examines the disparities between the available resources (financial, human, etc.), the services provided and the needs of patients at the regional level. With such a large number of relatively small medical facilities, however, it is very difficult to achieve cost effectiveness and ensure citizens' access to quality healthcare. È.Ï.È
Source: Other (09.05.2023)