A Managerial Decision That Has Boosted A Whole Health Care System


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  • The spread of cancer is marching globally. As one of the oldest European countries Bulgaria is not an exception. The negative trend related to this disease is so intense that nowadays 50% of all hospitals in the country don’t have cancer clinics but treat patients with cancer (according Ministry of Health of Bulgaria). The heaviest “front-liners” who lead the “fight” are the university hospitals – widely known as the high-end diagnostics, therapeutic, scientific and educational medical centers.

    University Hospital Saint Marina in Varna is one of the largest university hospitals in Bulgaria. It is equipped with hi-tech medical technologies designed to cure patients and save people’s lives with special accent on cancer. The most recent one was a positron-emission computer tomography (PET/CT) equipment.

    The radionuclides for the PET/ CT were delivered through a complex logistics coordinated and paid from the hospital budget from Hungary and Austria with a private airplane. The price of the isotope was 15 000 USD per 1 course (most of the cost was for its delivery). The time it took was so long that the FDG isotope (fludeoxyglucose F18)could be used only for one day after delivery due to the short radioactivity elimination half-life of 110 minutes. This allowed only 10-15 patients per course to be diagnosed. Many patients who were in need spent lots of money (and some even sold their properties) so that they can go for proper diagnosis in other countries.

    In 2013, the management team of the hospital decided to make a huge investment of 3 million USD in a cyclotron. Such equipment was the first for Bulgaria and the second in EU (after New Castle, UK). And that decision changed “the game” for all players in the healthcare system:

    For patients:

    • Increasing the quality of medical services by “closing the cycle” between diagnosis (PET/CT), treatment (chemotherapy, surgery, radiotherapy, immunotherapy, targeted therapy etc.) and follow-up;
    • Giving an opportunity for early diagnosis of cancer and its metastasis, including the smallest ones;
    • Increasing the number of diagnosed patients from 10-15 per course to 10-15 per day through producing individual doses for each of them (according their age, weight etc);
    • Allowing a lower cost for the diagnosis so it could be covered by the NHIF without the need for additional payments from the patients.

    For hospital budget:

    • Eliminating the cost for the expensive isotope logistics;
    • Decreasing several times the price of the individual dose.

    For health care system:

    • Introducing an innovation for the national healthcare system;
    • Allowing independence from the contracting, productionand delivery of FDG isotope.

    This is just an example… An example that in healthcare management, creative managers and their brave decisions can save people’s lives and spare nation’s money. And an example that with good management knowledge everything is possible – even a single hospital board to boost a whole health care system.

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    Mila Georgieva.
    The author is the Associate professor, Faculty of Public Health at the Medical University of Varna, Bulgaria. Ms. Mila is also associated with Eaton Business School as the Faculty for the Executive MBA in HealthCare Management program.

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