2024-07-11 00:32:18
The Supreme Administrative Court (SAC) has suspended the effect of provisions of the National Framework Agreement (NFA) for medical activities between the National Health Insurance Fund (NHIF) and the Bulgarian Medical Union (BUM) for the period 2023-2025. This was announced by the court on Wednesday.
The magistrates accept that the repealed provisions of the NSD regulate a ban on the NHIF to pay for hospital medical care provided by the medical facilities when the volumes and values specified in their contracts with the regional health insurance funds are exceeded, and related to this ban the activity of concluding contracts with the contractors of hospital care within the approved monthly values. The norms regulate the content of individual contracts, limited by fixed values, analysis of the information on the achieved implementation of the values, procedure for reporting the excess and for correcting the values, their documentary form.
The mentioned provisions limit the possibility of medical institutions for hospital care receiving payment in full for the activity performed by them when providing hospital medical care, in case they exceed the monthly values. The medical facilities have the obligation to provide medical assistance to the health insured persons, who, by virtue of the Health Act, have the right to affordable medical assistance by applying the principles of timeliness, sufficiency and quality of medical assistance; equality in the provision of medical assistance; cooperation, consistency and coordination of activities between medical facilities; respecting the patient’s rights, the court believes.
Therefore, the determination of monthly values for carrying out the activities of the hospitals could lead to the limitation of their activity due to non-payment of activities performed by the medical facilities, which would undoubtedly cause the occurrence of significant property damages for them. Timely and affordable medical assistance, provided under equal conditions and equal opportunities for treatment, is a fundamental right of health insured persons. Delaying the moment of its receipt can cause irreparable or difficult-to-repair damage to patients, VAS points out.
This puts health insured persons in the position of being denied medical care for financial reasons. Therefore, to the extent that the limitation of the activity of health facilities limits the right of the patient to benefit from his preferred hospital care in a certain medical facility, the effect of the contested regulations would limit, complicate and delay the provision of medical care, including it could lead to refusal to treat patients in the facility they have chosen are motivated by the court.
The decision can be appealed within seven days.