Sofia - Up to two million people - many of them of Roma origin - might be excluded from Health Services as of January next year, although Bulgaria intends to join the European union in two years time. This is one of the conclusions of the international humanitarian organisation Médecins Sans Frontières (MSF) in Bulgaria, published on a press conference held in Sofia today.
A survey among the patients of MSF showed the alarmingly high figure of people affected as well as the alarmingly low level of people informed about their future fate. Due to a change of the health system from a tax oriented to an insurance-based system, people in Bulgaria who were not able to pay their insurance in the last four years will have no more access to health care.
In Fakulteta, a poor district in Sofia where MSF has been successfully running a clinic that was opened exactly one year ago, more than 2,600 people out of the 7,776 patients registered are on the list of people threatened to be de-registered, if they don't pay their arrears of contributions by the end of the year.
MSF's position: Amnesty for years back
"We demand an amnesty for those who cannot pay back these huge sums, otherwise the health situation for poor people will get much worse than it is now. We intended to integrate the Fakultata clinic into the Bulgarian health system, but this will never be possible without an amnesty", says the Country Manager of Médecins Sans Frontières in Bulgaria, Ettore Larici.
"The General Practitioners who are supposed to continue running the clinic after the hand over from MSF, will lose 40% of their patients if there is no amnesty. The damage will be twofold: to the people who will have no access to health care any more, and subsequently to clinics like Fakulteta because the General Practitioners will have to move to better districts in order to be able to live on it.
"This can lead to the total abandonment of the building and the desertion of the area by the doctors", the country manager concludes. The health centre of Fakulteta is the only clinic for the approximate 20,000 inhabitants of the district.
Survey shows: No information
The MSF team in Sofia has carried out a survey among 964 patients in Fakulteta in order to learn more about the people affected and their way of dealing with the situation as well as to evaluate the level of awareness of people in the list about their situation. The results are devastating: 66% of the people claimed they didn't know they were in the list until the team of MSF field-workers confronted them during the interview.
Most of the people who say they do not understand why they will be excluded depend on social aid and thought that it was enough to be covered by insurance. They are shocked to learn that they need to pay for four to five years back before receiving further health service.
The worst result is the level of awareness: More than four years after the beginning of the implementation of the new health system, 77% of the people interviewed claim they don't know they have to pay 12 Leva per month as a contribution to the health system. Asked whether they would settle their bill before December 2004, 95% declared that they cannot afford it.
Roma minority: Most affected
Most but not all of the people affected are of Roma origin. Roma encounter usually more problems accessing health care than non-Roma. These barriers are due to poverty, uneven allocation of health facilities and personnel as well as communication problems between Roma and health care personnel. Existing information indicate disturbing inequalities between the Roma health status and the majority of the population: high morbidity and an average life expectancy 10 years less than the average for the rest of the population of the country.
MSF in Bulgaria: 8 years experience
Médecins Sans Frontières has been present and working in Bulgaria since 1997. Presently, the organisation is running a clinic where diagnosis prevention and treatment of sexually transmitted infections are accessible for everybody. Since June 2003, MSF is supporting the provision of Primary health Care services in Sofias district Fakulteta, where most of the Bulgarian Roma people live. MSF has been witnessing the changes in the health system since the beginning of the health reform five years ago.
MSF has assisted several General Practitioners in the Targoviste region to establish their practice in few villages and in the towns of Targoviste and Popovo. Furthermore, MSF has sponsored the upgrading of more than 60 GPs of the Targoviste region.