On 29 March 2006, medical professionals in hospitals began protest action organised by the Confederation of Labour Podkrepa. They protested against the severe cut in staff incomes ranging from 10% to 50% in several hospitals during the first two months of this year. The reductions are mainly due to the new financing system for state-owned and municipal hospitals.
Up to 2006, there were two sources of financing for state-owned and municipal hospitals – the state budget and the National Health Insurance Fund (NHIF). However, in 2005, there was a shortage of available funding for healthcare and the hospitals thus accumulated major debts, amounting to BGN 121 million (approximately €60 million) in January 2006, while the budgeted funds remained at the same level (4.3% of gross domestic product (GDP)).
However, since the beginning of 2006, the hospitals are being financed only by NHIF. According to the trade unions, the agreed prices for clinical procedures within the national framework agreement, for which NHIF pays, are unrealistically low. This has resulted in a further accumulation of debt for the bigger hospitals that offer better quality of treatment for a large number of patients.
As a result, social tensions increased among hospital staff as directors started making redundancies and reducing wages in order to manage the increasing debt. According to trade union data, salary reductions ranged from 10% to 50%.
Trade union reaction
The two trade union federations in the healthcare sector – the Confederation of Independent Trade Unions in Bulgaria (CITUB) and the Confederation of Labour Podkrepa (CL Podkrepa) – have reacted differently to these negative pay developments.
CITUB demands
On 10 March 2006, the Executive Council of the Federation of Trade Unions in Healthcare (FTUH) at CITUB made a statement demanding the following urgent measures to address the emerging crisis in hospital care:
- an increase to 6% of GDP in the allocated healthcare funds;
- a national agreement signed by the Ministry of Health, the social partners, the professional organisations, the National Association of Municipalities and patients’ associations. This agreement should determine the National Health Map and a minimum package of health services and care, guaranteed by the statutory health insurance;
- the setting of realistic prices for clinical procedures in each medical area;
- the conclusion of an annual agreement – signed by the Ministry of Health, the representative trade unions and employers in healthcare – on the wage budget for the healthcare service providers, before the signature of the national framework agreement;
- a specific law on hospital registration and financing;
- an amendment to the law on collective labour disputes resolution to revoke the provisions prohibiting strikes in healthcare.
FTUH warned that, if its demands were not met, it would immediately organise and initiate national-scale protest action.
CL Podkrepa demands
On 27 March 2006, while signing the collective labour agreement for healthcare, the Medical Federation of CL Podkrepa put forward a declaration of demands. At the same time, the federation announced that, from 29 March to 14 April, it would stage silent protests against the new healthcare financing scheme and against the wages being paid. The protests took place in 18 towns and 22 hospitals throughout the country.
The union’s demands were:
- to increase the 2007 healthcare budget to 8% of GDP;
- to provide for higher wages by allocating 40% of the cost of clinical procedures to remuneration of medical staff;
- that the state and the municipalities should pay their debts to the hospitals;
- to recognise the right of medical staff to take strike action.
Lack of unity
The trade union healthcare federations of CITUB and CL Podkrepa could not agree on a common plan of action for the protests and the CITUB members did not support the action of their colleagues even though their demands were almost identical. This lack of unity of action between the trade unions is likely to hinder the fulfilment of their demands and the future development of social dialogue in the healthcare sector (BG0601201F, BG0508201F).
View of health minister
The Minister of Health, Radoslav Gaydarski, considered the requested GDP percentage budget increase to be unrealistic. Moreover, he believes that problems in relation to remuneration will be solved with the new collective labour agreement that was concluded two days before the protest action. The agreement was signed by FTUH of CITUB, the Medical Federation of CL Podkrepa, the National Employer Association in Healthcare and the Ministry of Health.
Minister Gaydarski refused to negotiate with the demonstrators. He believes that improving the financial position of hospitals and clinics involves improving organisational structures, reducing cost inefficiencies and optimising their overall activities and management stuctures. Nevertheless, the Ministry of Health and the Ministry of Finance took action to alleviate the hospitals’ combined debt.
Tatiana Mihaylova, Institute for Social and Trade Union Research (ISTUR)