Corruption generated by the Mandatory health Insurance System

Participants to the broadcast: Galina Bostan, Director of the Centre for Analysis and Prevention of Corruption (CAPC); Iurie Osoianu, Deputy Director of the National Health Insurance Company (NHIC), Viorel Morari, Prosecutor, and Head of Division at the Anti-Corruption Prosecutor Office.

INTRODUCTION

During one of the earlier radio broadcasts of the “Corruption-Free Zone” we discussed about the corruption existing within the health protection system; we received a number of calls and written messages dealing with the topic of this radio broadcast. A part of these questions refer to the mandatory health insurance system. The given system was introduced in the Republic of Moldova in 2003 – the very year when all of us got familiarized with the “health insurance policy”. Is this system welcome or not? It is certain that this system is accumulating huge amounts of money, and when money is involved, usually corruption is present as well. Maybe this acknowledgment is true or maybe not for the Republic of Moldova, but the topic we would like to discuss today refers to “Corruption generated by the Mandatory health Insurance System”.

QUESTIONS:

1. Before starting the discussions dealing with this sensitive issue, I would like to refer to the information, data and opinion supplied by our citizens through CAPC hot-line: what do people say about the health insurance system?

2. The amounts collected by the NHIC are huge. In 2008 the allocated budget accounted for over 2,5 bullion lei, and almost 3,5 billion lei are planned for 2009.

The cost of the health insurance policy in 2003 accounted for 441 lei, while in 2008 it reached the level of 1893 lei, and an amount of 2637 lei is proposed for 2009. During a period of 6 years, the cost of the mandatory health insurance policy increased 6 times, while the volume of the insured health care did not witnesses a 6-times rise. People are not satisfied with the health insurance system. The conditions within hospitals did not change a lot. The wages of the medical workers remained to be ridiculous. So what actually happens to all this money?

3. In compliance with the Law on Mandatory health Insurance Funds for 2008, the administration costs for the mandatory health insurance system aiming to make more efficient the mandatory health insurance management accounts for 29 million 600 thousand lei. How is this money spent? What is the total number of personnel working within the National Company Health Insurance Company?

4. In case you have an accident and you do not have health insurance, you have great chances to be asked for money for your medical treatment.

The impossibility to present the health insurance policy or the referral from the family doctor are used as reasons for not granting the insured health assistance. When will the health insurance system get computerized? Are those 30 million lei allocated on annual basis for making more efficient the management of the system not enough for such purpose? Why should people suffer because of an inefficient management?

5. In compliance with the Law on Mandatory health Insurance, the pregnant women are insured by the Government.

Unfortunately, it is already well-known that all deliveries imply financial costs for the families, and the conditions within the maternity hospitals are extremely precarious. Were there any cases of real enforcement of art.14 from the given law regarding the insurer’s or health services provider’s liability for the volume and the quality of provided health services?

6. We know that there are people who pay considerable amounts for the mandatory health insurance, as they work within a number of working places and they have never benefit from health assistance: either they did not need it or because the exercise of this right is so complicated that sometimes it is much easier and quicker just to pay for the medical services.

Maybe it would be more reasonable for the insurance amount paid by the insured person to be an accumulation amount for the insured person to use it according to his/her own wish. For instance, to get a certain vaccine, or to have the possibility to treat his/her teeth once in two months, or eventually to have some plastic surgeries, if he/she wishes and if the amount accumulated on his/her account would be enough to perform such things.

7. Each of us has certain individual peculiarities, including health.

Some have problems with the liver, others have neurological problems, etc. For a number of patients it is possible to preview their health problems, thus they need an insurance of a higher volume for certain specialized medical services. Why NHIC does not develop insurance packages giving the possibility to people to choose the one they need? Maybe instead of the annual price-rise for the mandatory health insurance policy, it would be more useful to keep a minimum package of health insurance for a low price, offering the insured persons to manage their money when buying additional packages of specialized health insurance. In this way, spending exact the same amount of money, the health insurance policy becomes more useful for every patient.