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352 Economic crisis, health systems and health in Europe: country experience
• The National Health Insurance Fund implemented capped hospital budgets
by limiting the numbers of patients funded (2009, 2010 and 2011).
• The National Health Insurance Fund introduced delegated budgets for
hospitals (a maximum amount of money which the Fund would pay to a
certain hospital per month and per year) (2010).
Overhead costs: restructuring the Ministry of Health and purchasing agencies
• The new government announced plans to reduce administrative and
overhead costs in all government institutions by 10% (2009).
• The Minister of Health announced plans to reduce administrative costs
of the Ministry by 29.4% amounting to a saving of BGN 4 million
annually (2010).
• As a percentage of the Ministry of Health's total expenditure,
administrative costs decreased from 5.7% in 2008 to 2.4% in 2010.
However in next two years they rose again, reaching 4.9% in 2012.
• Changes instituted in the administrative and managerial structure of the
National Health Insurance Fund with the aim of reducing overhead costs
by several thousand Bulgarian levs (2010). The Fund's administrative
costs decreased from 3.0% in 2008 to 2.2% in 2012.
• The number of employees in the Ministry of Health and the structures
under the Ministry of Health was reduced. The National Centre of Public
Health Protection and the National Centre for Health Informatics were
merged into the National Centre of Public Health and Analysis. The 28
regional health centres and regional inspections of public health protection
and control were merged to form 28 regional health inspections (2011).
Provider infrastructure and capital investment
• Introduction of standards of competence with the aim of reducing the overall
number of hospitals and National Health Insurance Fund-supported medical
facilities (2010).
• In a reform funded by BGN 300 million from the European Commission,
the government proposed: stabilization and modernization of state oncology
hospitals and treatment centres; restructuring of some municipality and
state acute and long-term care hospitals; closure of some small hospitals;
modernization of state and municipality hospitals; and closure of homes for
social and medical care for children, which would be replaced by new day
centres (2010).
• The maximum numbers of beds, doctors and health establishments were set
for each region of Bulgaria (in addition to existing regulations specifying