THE REGULATION BY THE NHIF IN THE CONTEXT OF COVID-19 IN OPINION OF GENERAL PRACTITIONERS.

ABSTRACT

The regulation over the expenditure of public funds for health is carried out by the only institution in the Republic of Bulgaria, which is responsible for the activities of the compulsory health insurance-the National Health Insurance Fund (NHIF). At present, research in the area of control related to the legal and effective expenditure of the statutory funds at the first level of medical care is not sufficiently covered. The aim is to clarify the degree of appropriateness in terms of control over the implementation of contracts for the provision of primary outpatient medical care (POMC) in the context of COVID-19, as well as to reveal gaps and bad practices in the control process, which will help to formulate recommendations for its optimization. The article presents the results of a survey conducted among 394 GPs across the country for the period from 23.06.2022 to 16.10.2022 using the online platform Google Forms. The results show that among two-thirds of the surveyed GPs (71.6%) there are suspicions of an unjustifiably high number of activities rejected for payment by the Fund. In one third of the surveyed GPs, another type of control by the NHIF was significantly more frequent in district centres (43.1%) compared to other localities (29.1%). Nearly half of the GPs (45.8%) were covered by inspections based on complaints from dissatisfied citizens. The main findings imply that appropriate action needs to be taken in the direction of optimizing control by the NHIF in order to raise the authority of the controlling institution perceived by POMC contractors.Copyright © 2022, Central Medical Library Medical University - Sofia. All rights reserved.