Dynamics of general practitioners’ opinions on the NIHF’s control before and during the COVID-19 pandemic

General Medicine, 2023, 25(4), 3-12.

M. Djuglarska, T. Zlatanova, N. Popov, Ts. Petrova-Gotova, R. Yaneva, D. Shtereva-Tzоuni, E. Naseva, M. Lazarova

Faculty of Public Health „Prof. Tsekomir Vodenicharov, MD, DSc“, Medical University ‒ Sofia

Abstract. The importance of controlling the implementation of the limited public resources is incontestable when it comes to the national health system. In recent years, however, there have been sneaking doubts about the effectiveness of the control functions exercised by the only public provider in the system – the National Health Insurance Fund (NHIF). In this regard, the goal of this research is to study the dynamics of the opinions of the largest group of medical care providers, who are directly affected by the NHIF’s control – namely, general practitioners (GPs) – before and during the COVID-19 pandemic. For the purposes of the comparative analysis we have used concrete results obtained through distributing a questionnaire to 311, and respectively 394 GPs from all over the country, who were in contractual relations with the NHIF during the periods of February-August 2020, and June-October2022 respectively. The summarised results solidify the predominant opinion among GPs, which is to doubt the results of the NHIF’s preliminary control. The primary motives are that it is chiefly directed at detecting documentation oversights and/or incorrectly reported activities, which the NHIF refuses to remunerate, even if they have taken place, and not directed at identifying the unregulated practices in reporting activities, which are present according to a large share of the participants. There is a positive tendency in that the circle of those informed on the NHIF’s reasons for denying remuneration has widened during the pandemic. The doubt in the NHIF‘s control providing lawful, and respectively effective, implementation of regulated resources in primary outpatient care (POC) is solidified and expressed by the majority. The primary reasons are the document-focused nature of the conducted inspections, as well as not rendering into account the health effect of the implementation of public resources. The presented information, along with the additionally predominant share of activities the NHIF has definitively refused to remunerate in the conditions of COVID-19, explains the lacking proactiveness in challenging the NHIF’s remuneration declines. All this necessitates that actions are taken to discontinue the present unregulated practices, publicly render into account the health effect of the implementation of public resources, and comprehensively and clearly inform GPs about the reasoning behind decided remuneration for activities performed by them.

Key words: public resources, control, NHIF, POC provider

Address for correspondence: Assist. prof. Miroslava Djuglarska, PhD, e-mail: m.djuglarska@foz.mu-sofia.bg