18 January 2024
Ombudsman Diana Kovacheva sent a new recommendation in response to the problems of the e-notes from physicians to excuse absence from school and appealed to the Minister of Health Prof. Dr. Hristo Hinkov, the Chair of the Parliamentary Committee on Health Prof. Kostadin Angelov and the Chair of the Board of the Bulgarian Medical Association Ivan Madzharov that the notes be issued absolutely free of charge to parents and the operation be incorporated into the health service package financed by the budget of the National Health Insurance Fund (NHIF).
Moreover, Prof. Diana Kovacheva insisted that urgent solutions be found, that GPs and hospitals show understanding and stop charging fees to issue the notes or else collect minimal fees, e.g. in an amount as high as user charges.
The recommendation was provoked by further complaints and reports from parents to the Ombudsman Institution against the established controversial mode of how to determine the fees collected by GPs for issuing an electronic note to excuse the absence of pupils from school for medical reasons.
“I think that it is important to recall that when the medical notes of school absence were brought, I sent a special recommendation, to the Minister of Education included, where I pointed out that there is a risk of new administrative and financial burdens that parents would bear. Within the short period of existence of the requirement concerning the excuse of absence from school for any medical reasons, the public media, including the social networks, carried the opinion of medical doctors and of parents who expressed their discontent with this ill-conceived approach to excuse the absence of pupils from school. Parents describe the system as inefficient and non-performing as it does not solve problems to save time and economize on paper and on the contrary, annoys all “actors in the play’’ that is to supply an electronic note to excuse absence from school,” the Ombudsman wrote.
Diana Kovacheva reemphasized that this statutory requirement does not conform to the existing health system and even if the child recovers earlier, he/she must stick to the end date as given in the e-note. The Ombudsman recalled that at that time the National Network for Children, the Bulgarian Pediatrician Association, and the National Association of General Practitioners backed the citizens’ appeals and insisted on a really high-quality electronic service that would not be tested as an innovation on humans.
“It is a well-known fact that at the start of the new school year 2023/2024 three ministries announced the implementation of the new e-note to excuse pupils’ absence from school and that the publicly declared aim was to save time and money and to eliminate the circulation of hardcopy notes. Nonetheless, the automatic excuse of absence in the electronic school registers that enabled the communication of the schools and the GPs did not perform as planned,” the Ombudsman wrote further.
Prof. Diana Kovacheva emphasized that in her very first recommendation she warned that “the issuance of notes does not fall into the main package of activities that are covered by the NHIF budget” and that even at that time varying fees were reported as charged by the GPs, for example between 2 and 10 leva, but recent complaints from parents report drastically higher sums charged.
“In particular for big families and for parents in strained circumstances this becomes a serious difficulty,” Diana Kovacheva stated firmly.
She pointed out that hospitals and general practitioners are registered as companies and are free to fix their prices for the medical service but also for the administrative service and this is precisely why a few years ago a proposal was made to amend and supplement the legal arrangements and to incorporate the production of medical excuse notes into the basic package of health service defrayed by the NHIF (Section VIII of Appendix 1 “Medical Expertise Activities” where item 4 was reading: “Issuance of a medical note to a child/pupil for absence from a childcare center/school due to illness”).
“Unfortunately, this text dropped out during the discussion and after the approval of Ordinance 9 of 10 December 2019 to determine the package of health services covered by the NHIF budget that text was not to be found. Evidently, this activity was not agreed with the Bulgarian Medical Union. The fact is that due to its deletion, some medical doctors charge unreasonable high fees which are to the detriment not only of parents but especially of children,” the Ombudsman concluded and insisted on urgent action to solve the problem.