Health care is the first priority of the Bulgarians: faced with ‘Heart and Brain’ Sofia, the populists lose and disappear. Minister Kondeva, please decide and do not be afraid: the people will bless you!

“My main professional and research passion is advanced medicine and leading medical science. The management of a large research organization and the multifaceted methodical management of the newest and most modern hospitals inevitably led me to conceptual analyzes in health care policy in our country, Europe and developed democratic countries.

by Prof. Dr. Yana Simova, MD from Sofia, director of the Bulgarian Cardiology Institute, with over 400 scientific publications in leading world publications

Why did all of the Ministry of Health and National Assembly, who are against the licensing of “Heart and Brain” Sofia, fail and will fail in their political career?

Because they cannot answer the question of how this new hospital, which practices medicine and scientific research at the European and American level, will harm the legally guaranteed right to choose and the interests of Sofians, who have one of the lowest levels of satisfaction with the medical aid in the country and in the European Union. The primitive populism practiced in the last four years, in all forms, including through parliamentary control, has a severe conflict with itself. Populism does not have the dignity to recognize the simple truth that private initiative is competent, takes on the most serious pathology in hospitals outside Sofia, works modernly 24 hours a day and 7 days a week and has remarkably good social results for all – from low in-hospital mortality and high industrial productivity to record GDP and unprecedented tax collections.

The basic thesis of political populism that the “wronged masses” or “ordinary clean people” (in the terminology of Marxism – “the proletariat”) must oppose the “corrupt political elite” does not work here. Any camouflaged insinuations of an overstuffed health card are debunked by the fact of the thousands of empty licensed beds in the “label hospitals”. ‚Heart and BrainSofia has nothing to do with the political elites and even less with the corrupt part of them. The newly designed Bulgarian hospital is a “greenfield” private investment with a clear and clean structure, not privatization or offshore, and has not been injected with European funds or grants. Most importantly, ‚Heart and BrainSofia is open to everyone, regardless of age, educational qualification or financial status, language, gender, ethnicity, etc. constitutionally recognized and guaranteed, equalities, freedoms and rights. Absolutely perverse is the populists’ mantra “there is no need for a new big hospital in Sofia” – well, let people judge – if it dies as a non-preferred investment, the investment dies for the investor! Just issue the license and watch, but I, from the position of dignity and normality, predict that then all the populists will first seek help from some of us or my world-famous colleagues from the United States, Germany, France, Italy, the Czech Republic or Switzerland who are visiting for consultations and operations.

Competition in the democratic world of a market economy is a driver of development, and this is especially true of competition for quality in health care. My thousands of patients from Sofia and the whole country are outraged by the suppression of competition in terms of quality and the denial of the modern new hospital in the capital. Hundreds of colleagues, highly qualified doctors in public hospitals with thousands of patients, are also very outraged by the administrative arbitrariness and the Gonsurat disregard of the decision of the Supreme Court by the predecessors of Minister Kondeva, and we will all express ourselves in the elections very clearly. The reasons for the said behavior can be different – from clientelistic and guild accounts of maintaining the status quo to extortion and racketeering, but whatever they are, the inaction thus realized and continued is essentially blocking reform and trampling on the rights of patients. And no health card in its current snapshot of the status quo makes sense. However, it makes a lot of sense to draw up a road map for the development of the sector, in which the state performs at least one function properly – the regulatory one – and transfers all the annual subsidies of about 700-800 million, which it now distributes indiscriminately to failing hospitals in large cities, to the NHIF for better coverage and with the aim of reducing co-payments in hospital and pre-hospital care.

“Heart and Brain” Sofia accelerates and brings closer the reform of Bulgarian healthcare!

With leading results in cardiac surgery, cardiology, neurosurgery, neurology, oncology, orthopedics and two dozen other profile clinical specialties ‚Heart and BrainSofia will eliminate patient queues and raise clinical results in the capital. The competition for quality will force a number of units from the private and especially from the state and municipal hospital sector in the capital to reform without waiting for the intervention of the minister or the mayor. If, in parallel, the MoF stops every year subsidizing the bottomless debts of state hospitals, which sink into party or Shurobajan pockets, the treasury will calmly welcome the increased payments for performed and verified medical activity in all well-functioning hospitals and pre-hospital practices. This is the reform that people expect with increased scrutiny of compliance by everyone and a return of public health spending above 5.5% of GDP, even if it approaches 6.6% next year and cuts at least a little the huge lag behind the average European level. An honest assessment of the situation and the introduction of mass and unconditional competition on quality will carry out the reform, Madam Minister Dr. Kondeva, and please do not be afraid to issue the license, do not feel sorry for yourself or hide behind the short horizon of office tenure – You must too obey the law! Leave a bright administrative mark in Bulgarian healthcare in a record short time, and our love and dedication to modern medicine, teaching and research work will realize the reform.

Health care is the first priority of Bulgarians, and in the areas with predominant private hospitals such as Pleven, Burgas and Plovdiv, the average life expectancy is higher!

Primitive populists do not see progress, because they only see an encapsulated Sofia, and whine that the treasury budget this year has reached the “unseen” 8 billion. It is said that additional payments in hospitals and offices in Sofia exceed 50% of public expenses, without to have reliable data. My conclusion is that compared to the GDP that grew over 205 billion, even if we conditionally accept a total of 10 billion in health care costs in the whole country, they are extremely insufficient, because they are about 4.9% of GDP, which is at the bottom in the EU with levels from 7.2% to over 14.4%. Medical care, in-hospital and out-of-hospital, costs almost the same everywhere, both in Bulgaria and around the world, and therefore the treasury budget for 2024 will still not be enough! We provide European quality in hospitals at Bulgarian prices only because the work of doctors is undervalued and the cost of energy is still low, and above all because the population is not fully covered, is not diagnosed in time and is not treated, or is not treated in a timely manner , and often incorrectly, which leads to serious and expensive complications. The populists use the proportions perversely, even ridiculously, without distinguishing between the important ones. Until there is an objective, non-ideological, structural reform with clear regulation for strong national competition on quality and without permanent, arbitrary intervention with feverish subsidization, we will continue to lead the shameful and very sad rankings of general and child mortality in Europe.

Apart from the overall incompetence and corruption in the administration, no one is conducting a differentiated policy of helping the most vulnerable and needy social strata, especially in remote areas, who cannot pay extra, do not consult and diagnose and are treated only as an emergency. There should be a special fund to ensure the full realization of their constitutional rights to life and access to health care in the “welfare state”.

In the Netherlands, with entirely private hospital healthcare, patient satisfaction is the highest in the world. Bulgaria, at 33/67%, has not even reached Germany’s 60/40% ratio between private and public (state and municipal) hospitals. In Bulgaria, both new and old political parties are constantly sliding into populism, albeit in different forms and degrees, without having a clear long-term and realistic health political program or road map for reforms. And the people, my patients, want to know clearly when and what is next in the structure of health care and in other sectors, how long a number of families will desperately collect money for operations in private hospitals in Turkey and elsewhere, why competition on quality and modern investments continue oppress (?). For some of the ultra-populists, the market principle has no place in health care, and why in Turkey and in Europe, either the treasury or the ministry transfer money, instead of using “non-market, lofty” slogans for their treatment (?). Balancing with clichés or platitudes, often far from the literary language, has long lost its meaning and boomerangs in the form of a penalty vote or non-voting in the next and all subsequent elections.

Populists talk about values, many values, but in reality there are no new facts and coherent political decisions. Manifest failures in sectors reserved for exclusive state governance, such as justice and public order, security, defense capabilities, and even education, suggest that in health care permanent regulation be created to promote quality and the state will only increase control by simply allowing the current private investment drive to brought good nationwide results.

Anti-populist politicians must unite us by personal example and a pragmatic program, with deadlines, resources, accurate results and proven competence. The development of modern health care is a unifying theme, but no politician is using it for the national good of “unity makes strength“. People see and get angry, yesterday’s half-leaves often become weakly active or passive “politically corrupt elite” because they never wanted or could become honest and dedicated representatives of the people! These people, my patients, deserve my knowledge, work and respect, but all of us voters deserve the love and dedication of politicians, their honesty to the facts and a dignified attitude to promote development.

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