“Everything is going to explode.” Can a bed cure coronavirus? – Analysis

© Tsvetelina Belutova, Capital

The text was republished by Free Europe.

Many hospitals in Bulgaria are “opening” beds for the treatment of COVID-19 patients. This means that beds are placed in some rooms and are called “coronavirus compartments.” However, can a bed heal a sick person?

This question is asked by many doctors who are not specialists, but who are now required to treat COVID-19. And when hospitals do not have the necessary equipment and specialists, they cannot enter into contracts with the National Health Insurance Fund (NHIF). So who will pay for the treatment?

Experts warn that “this will all explode.”

In the last 24 hours alone, 182 people with coronavirus have been hospitalized. Currently, 4004 people infected with COVID-19 are in various medical institutions in Bulgaria. Just two weeks ago, hospital admissions were half as low. The upward trend shows that very soon today’s 4,000 will be much more.

Every day there are reports of a shortage of beds in hospitals. Relatives of patients complain that they cannot accommodate them for treatment. Several people died after being transported by ambulance from one hospital to another without being found.

In an attempt to control the crisis, in late October, Health Minister Kostadin Angelov ordered all complex hospital care medical institutions and cancer centers to provide at least 10 percent of their beds for COVID patients. -19. At that time, this requirement applied to areas with a morbidity of more than 120 people per 100,000 inhabitants. Today, all the districts of the country are called red areas.

But what does it mean to provide a bed? And does this mean that if you are hospitalized, you will be treated according to current health standards? The answers are in the following lines.

“I haven’t slept in a week”

Those admitted to hospitals with coronavirus infection are treated in three of the so-called clinical routes: this is how the activities and their value are described, which is financed by the National Health Insurance Fund (NHIF).

These are the roads with the numbers 39, 48 and 104. The national framework agreement between the NHIF and the Bulgarian Medical Union (BMA) describes the conditions for concluding employment contracts on these roads. They list what equipment, facilities and specialists each medical institution must have for the NHIF to conclude an employment contract in this way and, consequently, to recognize and cover the costs.

For example, lane 104 requires a physician specializing in infectious diseases; a medical laboratory specialist; medical specialist in diagnostic imaging. According to the National Institute of Statistics, the number of infectious disease specialists in Bulgaria at the end of 2019 is 210 and the number of pulmonologists, 610.

However, beds for COVID-19 patients must have all medical institutions that have contracts with the fund, regardless of what field they specialize in and what doctors they have.

“I have not slept for a week for fear that they will bring me a covid patient,” the owner of an ophthalmology clinic told Free Europe, who requested anonymity.

In response to the requirements of the Ministry of Health, there are also 10 percent of beds in ophthalmology clinics destined for coronavirus infection.

“I can only put drops in his eyes and bring him tea,” says the doctor. The clinic cannot conclude a contract with the National Health Insurance Fund on the treatment pathways for COVID-19, because it does not have the necessary equipment and specialists. If a patient is taken to the hospital, care will be borne by the medical institution or the patient.

The situation is not easier in municipal hospitals, where there is also a shortage of specialists. “We make living relics against the virus,” said the president of the Association of Municipal Hospitals, Dr. Nedelcho Totev. According to him, “we get diplomas from specialists in mothballs, but they are living relics.”

“We do not have hollow specialties in my hospital. We are not one of those who use only diplomas to sign itineraries. We do not have an infectious disease specialist. I have a 71-year-old pulmonologist. I used him as a consultant to sign patient documents. He is now in the He is dangerous to himself because he is not an infectious disease specialist. He does not have the attitude to remain one, “says Dr. Totev.

“I will put the beds in the park if I have to, but don’t make us break the law. I was the last to open the beds and told them that someone would come on the agenda to make us responsible for treatment,” he added. Totev.

What exactly is wrong

“It is not clear what happens to a patient if something happens to him. And if his relatives say that he has not been treated in a facility that meets the requirements for COVID-19,” said medical attorney Maria Sharkova. .

According to her, “the requirements to conclude and implement the clinical pathways are imperative and the lack of any of the requirements (for the presence of units, specialists, teams – br) is a reason not to conclude a contract or to terminate the contract and to demand the reimbursement of the amounts paid by the regional health fund in the respective clinical pathways ”.

Many hospitals that are required to open beds for patients with COVID-19 do not meet the requirements established in these ways: “for example, they do not have an open room for infectious diseases, they do not have specialists.” According to Sharkova, it is not clear how the aid will be paid in such cases.

“Free Europe” sent a question to the Ministry of Health and the National Health Insurance Fund: is there an order from the Minister, on the basis of which the National Health Insurance Fund to enter into contracts exceptionally for lanes 104, 39 and 48?

The answer says that “in case of an order issued by the RHI (Regional Health Inspectorate – BR) for the quarantine regime for the entire medical institution or individual structures, it is carried out only in the clinical pathway № 104”. The requirements for the roads approved in the framework contract are attached to the fund’s response, which, however, shows that there is no exception for required specialists.

Free Europe sent a follow-up question on how medical establishments without such specialists and equipment function, as well as whether there are medical establishments that have contracted with the NHIF to work on these clinical pathways without the relevant specialists, clinics and equipment. . and how the exception is regulated. We also ask on whose account the patients of medical establishments that have not entered into contracts with the National Health Insurance Fund according to clinical pathways 39, 48 and 104 will be treated, and who do not have the objective possibility of entering into such contracts, such as ophthalmological clinics.

“The National Health Insurance Fund concludes an employment contract on all roads under the conditions described in the National Framework Agreement (NDA), which cannot be revoked by order of the Minister. Contracts are concluded on these roads under the conditions described in the NDA, “the fund said. .

The president of the Center for the Protection of Health Rights, Dr. Stoycho Katsarov, commented that it is impossible for the fund to conclude contracts for new paths with medical institutions, “when applications are not submitted on time, and this period was January.”

By law, the object of complementary contracts and agreements cannot be extended. “Also, this room cannot be opened by order of a minister. The hospital wants it and the minister approves it or not,” said Dr. Katsarov. According to him, “all this will explode when a patient dies in such a room and begins to claim his rights. But the responsibility will not be borne by the fund, but by the doctors who admitted him.”