In 1998, the National Assembly adopted the Health Insurance Act (HIA). With it, compulsory health insurance was introduced in our country. By virtue of Art. 6, para. 1 of the Health Insurance Act, the National Health Insurance Fund (NHIF) was established, which started functioning on March 15, 1999. Its main task is to implement and administer the compulsory health insurance in Bulgaria, in its part for the management of the funds raised and the payment of the used health activities and medicines (within a certain scope and volume) in favor of the health insured persons.
With the Health Insurance Act, the collection of health insurance contributions was initially assigned to the National Social Security Institute (NSSI), and since January 2006 – to the National Revenue Agency (NRA).
The National Health Insurance Fund is a legal entity consisting of a Central Office – based in Sofia, and regional structures in each of the 28 regional centers of Bulgaria.
The main goal of the NHIF is to provide and guarantee free and equal access of the insured persons to medical care – through a certain type, scope and volume of a package of health activities, as well as free choice of contractor with a regional health insurance fund (RHIF).
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With its activity the National Health Insurance Fund aims to improve the quality of life of Bulgarian citizens by regulating and increasing the social, health and economic efficiency of health care costs; improving the quality of the services provided and the equality in their use; introduction of mechanisms for decent payment of medical specialists, as well as a positive change in the relationship between doctor and patient.
Compulsory health insurance in Bulgaria is carried out on the basis of the following basic principles (Article 5 of the Health Insurance Act):
Compulsory participation in the collection of health insurance contributions
This principle is characteristic of modern social security (including health insurance) systems. It envisages the collection of revenues in the NHIF from health insurance contributions from all Bulgarian citizens.
Participation of the state, the insured citizens and the employers in the management of the NHIF The
National Health Insurance Fund is a public organization and its structure follows the following logic: the funds should be managed by those who give them. Tripartism “employers, state and insured” is the basis of the management of the processes in the NHIF.
Solidarity of the insured citizens in using the funds raised in the NHIF
The principle of solidarity provides for the possibility of the following redistribution of funds from health insurance contributions: from the healthy to the sick, from the rich to the poor, from the young to the elderly.
Liability of insured citizens for their own health
Each insured citizen must show individual responsibility for their own health by complying with the prescriptions of medical care providers and the requirements for disease prevention, in accordance with the National Framework Agreement and the contracts with contractors (Art. 38 from the Health Insurance Act).
In order to achieve a higher level of responsibility for their health, the insured citizens pay a certain fee when using medical services. The user fee, the amount of which is fixed in the Health Insurance Act, is minimal and does not depend on the value of the consumed services. For each visit to the doctor or to the dentist, as well as for each day of hospital treatment, but not more than 10 days a year, the health insured pay to the doctor, to the dentist or to the medical establishment amounts determined by a decree of the Council of Ministers .
Certain groups of citizens are exempt from paying this fee: persons with diseases listed in the R&D; as well as minors, minors and non-working family members (spouse, wife, children up to 18 years of age, and if they continue their education – up to 26 years of age, and if they are incapacitated or permanently incapacitated – regardless of age); injured in / or in connection with the defense of the country; war veterans, war invalids; persons detained in custody on the grounds of Art. 63 of the Law on the Ministry of Interior, detained on the grounds of Art. 125, para. 1 of the Law on the State Agency “National Security” or imprisoned; socially disadvantaged, receiving benefits under the Regulations for implementation of the law on social assistance; persons accommodated in homes under Art. 36, para. 3, item 1 of the same regulations; medical specialists, as well as pregnant and postpartum women up to 45 days after birth, patients with malignant neoplasms and health insured persons suffering from diseases with over 71% reduced working capacity. (The full list of diseases, the sufferers of which are exempt from paying the user fee under Article 37 of the Health Insurance Act, is an integral part of the National Framework Agreement.).
Equality in the use of medical care
Access to medical care is a basic requirement of European social health insurance systems. Within the package of medical services guaranteed by the NHIF, all citizens have equal rights to access medical care.
Self-government of the NHIF The
NHIF is established as an independent public institution, which is separate from the structure of the public health care system and has its own governing bodies.
The NHIF budget is separate from the state budget. The draft Law on the Annual Budget of the National Health Insurance Fund is considered by the National Assembly simultaneously with the draft laws on the state budget and the law on the budget of the state social security. The NHIF Budget Act determines the amount of the health insurance contribution.
Representatives of the insured persons who defend their rights also participate in the management of the NHIF.
Negotiating the relationship between the NHIF and the providers of medical care
According to the Health Insurance Act, the financial relations between the NHIF and the providers of medical care are agreed on two levels: nationally – by concluding a National Framework Agreement (NDA) with the professional organizations of doctors and dentists, and individually – by signing individual contracts with contractors. If providers of medical or dental care do not wish to conclude a contract with the health insurance fund, the activity performed by them will not be paid by it. For its part, the NHIF may refuse contracts to providers of medical and dental care if they do not meet the requirements for concluding a contract and for providing quality treatment.
Free choice for the insured citizens of medical care providers who have concluded a contract with the RHIF
With the introduction of the health insurance system, the freedom to choose a provider of medical care is guaranteed. Insured citizens have the right to use the services of medical professionals, as well as medical and health institutions that have concluded a contract with the health insurance fund, regardless of their form of ownership.
Publicity in the activity of the NHIF The
NHIF publishes on its website: the National Framework Agreement, the decisions and minutes of the meetings of the Supervisory Board, its budget, as well as reports and regulations for its activity.
The Health Insurance Act provides for wide opportunities for both public and financial control over the activities of the NHIF, carried out by: the Council of Ministers, the National Assembly, the National Audit Office, the State Financial Control.