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MSF in BulgariaLast updated: July 2005 Two million in danger of losing health insuranceMSF has been helping residents of Sofia's large Roma community gain access to health care services for a number of years. However, in 2004, the Bulgarian government took steps to throw two million poor Bulgarians out of the health insurance system because they had failed to make regular payments into the new insurance scheme. MSF has been advocating on behalf of the most vulnerable to ensure that they learn about their responsibilities under the new system and receive amnesty for overdue payments. MSF fears that many of the country's poorest inhabitants will lose access to care if the system goes ahead as planned. In addition, the organization continues to treat people with sexually transmitted infections and works to improve the quality of that care. A confusing fee systemFor the last four years, the Bulgarian health care system has been moving from a model fully subsidized by the state through general taxation, to one almost entirely financed through insurance. Under the new system, health insurance is compulsory for everyone and calculated as 6% of a person's salary. Pensioners, the registered unemployed, children below the age of 18 and students are insured by the state. During the system's first years of operation, the government did not enforce the compulsory payment of fees . Regardless of whether or not people paid their monthly contribution, they continued to have access to health care services. However, this year, the national health insurance organization started enforcing payment. It recently requested that all of those who had not paid their monthly contributions since the start of the new system be excluded from the insurance system. The number of people affected by this new rule is estimated to be between 350,000 and two million people. Many people now owe money for months or even years in which they did not pay any contribution. In response to this dire situation, MSF organized a media campaign at the end of September 2004, in which it demanded amnesty for back payments . MSF advocated for this solution as the amount of money owed makes an insurmountable obstacle for many of the country's poorest residents. MSF also called on authorities to better inform the public about the system and to let people know quickly if they fall behind in payments. At the end of 2004, the Bulgarian government amended the law on health insurance. The current law now calls on those in arrears for 15 months to pay a punitive fee (equal to 18 euros) in early 2005 that will place them back on the insurance rolls. Once that is done, the person must continue to pay his or her monthly contribution. Failure to pay will result in removal from the list again. All of t hose with back payments must settle their account by the end of December 2005. In addition, the government has decided to cover owed payments for poor people (that is, those who have requested subsidies for winter heating costs). MSF believes that the amendments are only a cosmetic solution to the ongoing payment dilemma. The organization argues that the real social problem remains unsolved and will simply be inherited by the next government which will be chosen in September 2005. MSF has worked in Bulgaria since 1997. |
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