No access, no future
As of January 1, 2005, 10% of the people in Bulgaria might be excluded from health services.
The following testimonials are some of these people who will not have access to medical care unless they pay back to the National Health Insurance Fund the fees of the last years.
Médecins Sans Frontiéres (MSF) demands an adaptation of the system so that there are no dropouts of the Health System as of January 1, 2005 and an amnesty for patients who did not pay fees in the last five years.
"Where can I find that kind of money? I might as well hang myself right away. There is no work anywhere, my present contract is only until December. Until now God took care of us, we were seldom sick. But that was the main reason why we did not know it. Maybe if someone were sick we would have known. There are many people in the same situation like me, I never believed that this will happen. What will happen after January 2005?"
Kalina works part time in the MSF clinic since August 2003. Before that she worked in construction companies as a labourer for ten years, afterwards she was unemployed, then she had different jobs as a cleaner until 1994. From then on she was unemployed until her job with MSF in 2003.
Her husband - he works sporadically and unregistered, as porter for heavy furniture - is unemployed. Sometimes he has a bad back, but otherwise they are both healthy. Kalina knocks on wood that it remains that way. From the beginning of the system until 2003 they never visited a family doctor, for urgent matters they called an ambulance. Now that they know the system, the family chose a doctor.
Kalina has three children, two boys and one girl. They are all grown-up. The elder son is a field worker with the foundation of health and social development. The second also worked there for six months, but not anymore. The daughter found work only last year. So only one of her children is covered through the health system, the other two and her husband not.
Kalina does not understand the system, although they talked many times about it, she had even heard on TV about it. The eldest son talked at home about it, he is afraid for the family as of next year and tried to find official work with insurance for everyone. The daughter is illiterate, she is working in a small store for construction material and cleans offices there.
Kalina never understood the system. She stopped signing during the time she was unemployed because there was no benefit of signing for her. They did not inform her properly that she was not covered. Once somebody told her the consequences but she forgot. If you forgot the date and did not sign each month for 6 months on a specific day, you are not covered. She did not know that it was linked with insurance.
Kalina would have to pay 576 Leva plus interest in order to be covered in future.
"I am feeling so guilty, it is my fault that I am not insured. But these 2000 Leva are just too much for me, and the amount is getting higher, it is a vicious circle. I just hope I will not get sick!"
Tania is 52. She is a Bulgarian woman, mother of two children. One daughter is a lawyer, the other will be an art student soon. Tania's own background is agronomic engineer, she has worked in different places and was registered until 2001.
Then, Tania and her husband founded a company, which was registered in her name. They paid social insurance whenever they could. When she started to work with MSF as a cleaner, she stopped paying, not knowing that as owner of a company she has to continue paying herself.
When she realised that and wanted to pay, she was told that she has to pay social insurance before health insurance, which would be 2000 Leva compared to 150 Leva for health insurance. If there was an amnesty, she would start paying immediately, but the amount is too high.
"I would never do that again, but I did it to save my boyfriend and I did not know the consequences. People do stupid things sometimes.
I am dreaming of a bigger house or a small flat, I am so ashamed of the dirty little room where we have to live right now."
Stefka has three children, Swezana, Mario and Albena. Albena is often ill. She was in hospital already four times, but without her mother. Stefka had to leave her there, because she could not afford the 5 Leva per day it would have cost her to be with her youngest child. She cried all day, but just could not help it. Besides she had to care of the other children.
Stevka lives together with her boyfriend and her three children in a small room in a little hut, right in the middle of the rubbish of Glaveva, a part of Fakultata consisting of small huts and makeshift houses. Stefkas boyfriend is unemployed, he spends his days checking rubbish for valuable things to sell. Sometimes he earns 20 Leva, sometimes only 2 Leva.
Stefka got a notice that she was on the list of people not covered by the health insurance.
The reason: Stefka is not entitled to it, she is married but can not produce family incomes document.
Her story: Stefka wanted to help her boyfriend (and father of her three children), he was in debt and desperately needed money. She was asked if she would marry him for money in order to get the citizenship for him. She agreed in order to save her boyfriend. Only after the marriage she realised that, as she could not provide low income documents of her legal husband, she has no more right for social help. She wanted to get divorced, she asked her husband for it. He came and gave her a total sum of 280 Leva but refused a divorce. Only after three years will he divorce her as then he is allowed to stay in Bulgaria.
"There are so many people without insurance - what will we do after the 1st of January?"
Bozidar means 'Gift from God'. In fact, Bozidar is always there for other people. Living in the center of Fakulteta slum Glaveva, he helps others as good as he can. He even adopted a child, although he already had three to cope with. The child's mother was a prostitute and he did not want her child to end up in an orphanage.
Bozidar is not insured, his wife is not insured, the daughter is not insured. He has no job, so he spends his time as volunteer for other people in Glaveva.
Bozidar is a driver, he worked for 20 years. Eight years as a bus driver, after that as taxi driver. After that he got a job as taxi driver and thought that he was insured properly, but when his wife lost her job he realised that in the taxi company out of 200 drivers only 10 were insured.
The insurance institute was alarmed, the company had to undergo an audit. However, things did not change for Bozidar, he was still not insured so he left the company after a few months. After that he tried to insure himself but it was more than 70 Leva per month. He could not afford this amount and had to stop paying. Since February 2004 Bozidar is completely out of work, so he spends all of his time helping in the community of Glaveva.
His wife Emilia earns 120 Leva per month, but she only got work since 1 month. She is employed on a temporary basis for 'Beautiful Bulgaria', a program funded by the EU. Presently she is cleaning a pool in a big sports complex in Sofia, her contract is limited to four months.
It is impossible for them to pay four years back, but they would be willing to pay the 12 Leva in future.
"I tried so many times to find a job, I just have to find a job, my wife and my three children depend on me. This system is so unfair."
Stevcho has four kids, age four, seven and thirteen. His wife is very sick, she has pulmonary problems and neurosis. Stevcho was unemployed for many years, in fact since 1998. However, he was always registered in social services. He signed every month, he worked every month for five days for the public in order to receive social help.
One year ago, in summer 2003 he was proposed a job in a cemetery. He started working there right away. Suddenly, his wife got very sick and he asked for a few days of unpaid holidays in order to take care of her and their children. His boss at the cemetery told him that he was even entitled to 10 days paid holidays in a case like that. So he took the 10 days. On the 6th day he received a letter, he was to come to work immediately. Apparently there was a mistake and he had no right to these 10 days since his employment was on the basis of an unemployment program. Stevcho went immediately back to work.
Since that day things changed for Stevcho. His boss could not cope with the fact that she had been wrong, so she put the blame on Stevcho and started mobbing him. She sent him to repair a fence outside of the cemetery, telling him that there were several holes in it. It took many hours for him to repair and check the fence. His boss did not believe that he really worked on that fence, although he was together with a colleague. She refused to pay him for that day. Next day the same thing was repeated, he got the order to clean some place and wait for his boss then to check it, but she never came. Instead she was refusing him payment for that day, arguing that he did not work. After several days she dismissed him and his colleague.
Stevcho went to the employment office but was told that it is up to his employer to judge him. After confronting his former boss, she told him that he had threatened her job because of the mistake of the 10 days absence.
The consequence for Stevcho: For one year he and his family have no social help and no health insurance.
"I would divorce him right away, but I cannot afford it. It costs 300 Leva, and I just do not have this kind of money."
Giula means Rose. Indeed, Giula is a very pretty young woman. Together with her boyfriend and her two year old boy she lives in a small flat in Vietnamese, a part of Fakultata where many Vietnamese people used to live. Giula never went to school, she can neither write nor read properly.
Giula was registered and got social help, but only for a few months. Then she married. Her husband gave her 100 Leva then disappeared. Now she has no right to apply for social help nor to health insurance. She was trying to find her husband, but it was impossible. Without a divorce she has no chance to social or health insurance.
"The system does not help me, I would only pay if there is less bureaucracy. As it is now, you have to take a full day holiday just to go to the insurance institute."
Ivo is a typical Bulgarian. Young, independent and not overly concerned about his health. He worked in several jobs before, importing cosmetics, being a bodyguard.
Ivo did not pay taxes, therefore he has no right to health insurance as of 2005. His employers did not give him an official contract, and he did not care. He has no obligations and therefore is not thinking about being insured or becoming sick. If he gets sick, he goes to a doctor and pays directly. But he is hardly ever sick, so it is not something that bothers him.
"We will never be able to finish our house and get our son to university if we have to pay back this huge amount."
Vasilka was offered a job as a cleaner in a school. It was the school of her son He was the only Roma boy there. Nobody in his class knew he was Roma, they feared discrimination when people realised that the Roma cleaner is his mother. So Vasilka refused this job offer and asked the employment office to propose another school. The office refused and insisted that she had to take this offer, but Vasilka just could not do it. Now she is rejected by the system for a year. She cannot sign for social help nor has a right to social and health services until August 2004.
Since a few months she has a contract as a field worker for MSF. It is a small job, 9 hours per week but it brings in some money. Her boy is finishing school soon, she hopes that he will be a doctor sometime.
Stravko is working as a gravedigger, but without an official contract. They are living in a small house in the centre of Fakulteta.
Vasilka is willing to pay the 12 Leva per month, but the old debt is impossible to repay. She is afraid to go to the insurance institute, fearing that they would confiscate the few belongings they have such as furniture and a TV-set in order to get their 1200 Leva.