Latest news with #NHIF
Euractiv
3 days ago
- Health
- Euractiv
Bulgarian hospital fraud going unchecked despite patient digital verification app
Only 3% of Bulgarians who regularly pay health insurance contributions have accessed their electronic health records via a mobile app introduced by the government, according to exclusive data provided to Euractiv by the Ministry of Health. The app was launched to curb fake hospital admissions and financial abuse in the healthcare system. As of the end of 2024, only 160,000 citizens had requested and obtained access to their e-health records via the 'eZdrave' smartphone app, and even fewer - just 80,000 (1.5%) - had actually used it. Bulgaria has 5.7 million insured citizens (87% of the population), while the remaining 13% are only entitled to emergency care under national law due to non-payment of contributions. In early 2024, the Ministry launched the free eZdrave app to provide citizens with access to their digital health records and those of their underage children. The app sends real-time notifications for all medical services received. 'By accessing their e-health records, citizens can help safeguard the system from abuse and public fund theft. If services appear in their file that were never provided, they can report it to the authorities,' the Health Ministry told Euractiv. Low oversight fuels hospital fraud A ruling by the Constitutional Court in 2024 stripped the National Health Insurance Fund (NHIF) of some of its key tools for hospital spending control, leading to an unchecked rise in admissions. In just one year, hospitals reported 200,000 more admissions than planned, resulting in over €200 million in overspending. In June 2025, the government announced it would begin sanctioning hospitals and doctors for claiming payments for medical services that were never performed. Still, the system relies on citizens to verify these services - a task they appear largely uninterested in. Calls for legislative changes to improve oversight have gained little traction. In May, an opposition MP from the liberal Democratic Bulgaria party proposed a bill requiring the NHIF to send citizens an SMS every time they are admitted to a hospital, enabling them to detect fraud if false admissions are made in their name. The governing majority, led by the centre-right GERB party, rejected the proposal. 'This is an effective prevention mechanism. If hospitals know that patients will be notified, they will stop misreporting. But we cannot verify how widespread the fraud is, as offenders use real ID data. If victims don't report it, it's impossible to uncover,' the bill's sponsors from the Democratic Bulgaria told Euractiv. Insufficient funding's part Alexander Simidchiev, a member of the parliamentary health committee, added that chronic underfunding in Bulgaria's healthcare system incentivises hospitals to simulate excessive hospitalisations to balance their books. During parliamentary debate, GERB MP Lachezar Ivanov countered that citizens already have access to all their health data via the eZdrave app and warned that SMS notifications for all admissions would impose a significant financial burden on the NHIF. The opposition, however, estimated the cost of such a system at no more than €500,000. Euractiv's reporting suggests that the app's limited reach means digital access alone cannot ensure effective citizen oversight in a healthcare system plagued for years by misuse and corruption. In 2025, Bulgaria's parliament approved a record healthcare budget exceeding €4.6 billion, almost half of which is allocated to hospitals. [Edited by Vasiliki Angouridi, Brian Maguire]
Euractiv
7 days ago
- Health
- Euractiv
Bulgarian court ruling widens access to lifesaving drugs
In a significant legal development, Bulgaria's Supreme Administrative Court has overturned a decision by the National Health Insurance Fund (NHIF) regarding a patient with a rare disease's access to medication, opening the door for patients to receive life-saving medications not included in the country's Positive Drug List (PDL). The ruling could have far-reaching implications for people suffering from rare diseases or cancer who are currently excluded from reimbursement due to regulatory loopholes. Dr Antoaneta Toncheva, geneticist and member of the Bridges Community Association, welcomed the news. 'This is the best news I've had in weeks! A small-big step that I hope triggers a landslide of change,' she remarked. Reimbursement obstacles For medicines to be reimbursed, they must be on the so-called 'positive list'. The list determines which medications are fully or partially covered by the state, outlining conditions for prescription, including eligible diagnoses, prescribing specialists, dosages, pricing, and reimbursement levels. Medications not on this list are generally excluded from public funding. However, it is not the only barrier to access. A 2019 ministerial regulation stipulated that only patients under 18 or those who began treatment before reaching adulthood were eligible for reimbursement. Landmark case The court ruling concerns a 21-year-old man diagnosed with a rare genetic disease, Neurofibromatosis Type 1 (NF1). This is a genetically rare condition characterised by the development of multiple tumours. They are not malignant, but they have the potential to become so eventually. The state Health fund had denied funding for his treatment with Koselugo (INN Selumetinib), arguing that under a 2019 ministerial regulation, only patients under 18 or those who began treatment before reaching adulthood were eligible for reimbursement. However, the court found this regulation to be incompatible with Bulgaria's Health Act, which stipulates that treatment outside the scope of mandatory health insurance must be provided under conditions set by the Minister of Health. The judges ruled that the law takes precedence over the ministerial ordinance. Important precedent Expert testimony in the case highlighted that without treatment, the patient risks severe disability. Koselugo blocks specific proteins involved in tumour growth and is expected to reduce the size of plexiform neurofibromas. The court concluded that denying access to the drug based solely on age violated constitutional principles of equality, proportionality, legal certainty, and the protection of legitimate expectations. 'The Constitution obliges the state to protect the health of all citizens without age discrimination,' the ruling states. The judges emphasised that the goal of public health regulations is to ensure quality and accessible healthcare for all. All insured individuals are entitled to free medical assistance, including prescription and access to approved medications, medical devices, and specialised dietary products for home use. Therefore, the NHIF director should have applied the law directly rather than relying on the ministerial ordinance, the court argued. 'The fact that the patient is over 18 does not make him any less in need of state-funded medical care,' the ruling reads. Lawyer Maria Sharkova, who represented the patient, told Euractiv that the ruling sets a precedent for others in similar situations. 'Any patient in need of treatment with a drug outside the list, if it is proven safe and effective, can now rely on this court decision,' she explained. Access improved via courts At the end of 2024, Bulgaria's Commission for Protection against Discrimination concluded that the state systematically discriminates against patients with rare diseases and cancer. The decision followed a year-long campaign by the Bridges Community Association. Although the first court ruling upheld the Commission's findings, the Parliament and the Ministry of Health appealed rather than address the legal shortcomings. The case is now awaiting a final decision from the Supreme Administrative Court. This is not the first time the judiciary has expanded access to healthcare in Bulgaria. In 2024, the Constitutional Court struck down the core financial limits on hospital treatment imposed by the National Health Insurance Fund. As a result, the national healthcare budget increased by 15% within a year, reaching €4.5 billion. Despite this increase, experts warn that the current budget may still fall short of covering the growing healthcare demands triggered by recent legal rulings. [Edited by Vasiliki Angouridi, Brian Maguire]
AFP
29-04-2025
- Health
- AFP
AI-generated video of Kenya's president falsely linked to new health insurance scheme
Kenya's President William Ruto launched the Social Health Authority (SHA) in October 2024 to replace the National Hospital Insurance Fund (NHIF) as the state's health insurance provider, prompting criticism from his opponents. Yet a TikTok video that claims to show him 'preparing' a hospital patient for the press launch has been created with AI software from an image taken in 2019. The original photo shows Ruto, who was then deputy president, visiting a victim of a terror attack. 'Behind the scenes, Ruto spotted preparing, a patient, to launch SHA (sic),' read a TikTok post published on April 19, 2025, and shared more than 100 times. Image Screenshot of the altered post, taken on April 23, 2025 The caption alongside the video claimed Ruto was 'mocked' live on television during a panel discussion hosted by Citizen TV on April 17, 2025. Although the discussion was unrelated to Kenya's new healthcare system, one panellist said Ruto had 'launched' -- meaning directed -- a patient in a public relations stunt to prove that the SHA was working well (archived here). A day earlier, Ruto had commissioned the first Kenya Defence Forces hospital for the general public (archived here). The clip appears to show Ruto standing next to a hospital bed interacting with a patient as he adjusts her bed cover. Two doctors stand next to him, while three other individuals in suits are seen reflected in the mirror above the patient's bed. Beeping sounds can be heard in the background. The post was published by an account -- with more than 49,000 followers -- which predominantly shares AI-generated content. New state insurance scheme The Kenyan government officially launched the SHA on October 1, 2024, as part of its plan to expand access to Universal Health Coverage (UHC) (archived here and here). The new system, which is mandatory for all Kenyan residents including expatriates staying for over a year, aims to fill the gaps in the former NHIF by expanding the scope of care to include new services such as cancer and common health conditions screening. It also offers a wider range of outpatient services and includes standardised surgical tariffs across all healthcare providers (archived here). But since its inception, the insurance scheme has been criticised for poor communication, an unclear implementation framework and its procurement process (archived here and here). Despite its shortcomings, Ruto has continued to defend the SHA and has urged Kenyans to register for the new health plan (archived here and here). The TikTok video claiming to show Ruto using a patient to promote SHA is, however, doctored. Old image animated AFP conducted reverse image searches on keyframes from the clip and found a photo depicting the same event published on Facebook by Kenyan news outlet Citizen TV on January 17, 2019 (archived here). 'DP Ruto visits victims of 14 Riverside terror attack,' read the post. Several clues point to the fact that this image was animated into a video using AI software. The first frame is an exact match of the original photo and is typical of how photo-to-video AI tools such as Vidfly and Invideo AI work – by starting with an image and adding a prompt to generate a video. Image Screenshots comparing the altered post (left) and the original photo published by Citizen TV One second into the video, the patient's left arm goes missing, only to appear after Ruto seemingly adjusts the blue bed cover. Image Screenshots of the altered post showing the patient's missing left hand (left) and the moment it appears A second later, the patient appears to push the blanket. Both her fingers and Ruto's seem to distort as they move. Image Screenshots from the altered post showing Ruto's and the patient's hands morphing as they move Further searches revealed a genuine video of Ruto's hospital visit shared on Facebook by a Kenyan news blog Thika Town Today on January 17, 2019 (archived here). In it, Ruto can be seen shaking the same patient's hand while resting one hand on her knee and then pulling away, unlike in the TikTok video where he starts fluffing the blue bed cover. The white and blue-striped sheet on the patient's bed to her left was also edited out of the TikTok video. Another discrepancy is with her left hand: it remains under the covers in the video from 2019 but is visible in the TikTok clip. Image Screenshots comparing the altered clip (left) and the original video published in 2019 Citizen TV also published footage of Ruto's 2019 visit to the Aga Khan Hospital in Nairobi (archived here). Although not identical to the Thika Town video, both sets of footage feature some of the same patients as well as Ruto's interview with the media.
Zawya
28-04-2025
- Health
- Zawya
Cabinet Secretary (CS) Duale Urges Kenyans to Enroll in New Social Health Authority Scheme
Health Cabinet Secretary Hon. Aden Duale has called on Kenyans to register in large numbers under the new Social Health Authority (SHA) to access universal health coverage. Speaking at a fundraising event for Harhosa Mixed Day Secondary School at Moyale Baraza Park in Marsabit County, Hon. Duale emphasized that the SHA system allows individuals to register up to four wives and an unlimited number of children, provided they can prove dependency. Hon. Duale noted that SHA provides comprehensive coverage for all Kenyans, a significant improvement over the now-defunct National Health Insurance Fund (NHIF), which was primarily designed for employed citizens. He stressed that the shift towards a more inclusive model is essential to ensure every Kenyan can access affordable healthcare services, regardless of their employment status. He also criticized opponents of the SHA reforms, describing them as cartels who previously exploited loopholes within the NHIF for fraudulent gains. Distributed by APO Group on behalf of Ministry of Health, Kenya.
