A draft for changes in the Ordinance on determining the package of health activities, guaranteed by the budget of the National Health Insurance Fund, provides for significant corrections concerning outpatient and hospital care. The draft is published on the website of the Ministry of Health (MoH) for a one-month public discussion, which emphasizes the commitment to transparency and the opportunity for public participation in determining the future of health care.
In the field of primary medical care, the introduction of an activity for the administration of targeted immunizations is envisaged. Targeted immunizations, recommended for groups of the population at increased risk of infection, will be financed through vaccines purchased by the MoH. The focus is on vaccination against pertussis for pregnant women between the 27th and 36th week of gestation, which is already being applied in the country. In addition, in 2026, the inclusion of targeted immunization against respiratory syncytial virus, again for pregnant women, between the 24th and 36th week of gestation is planned.
The changes also affect general practitioners, as it is proposed to remove the obligation to prepare a health-prevention card/coupon, as well as to issue documents regarding immunization status, required for kindergartens and schools. The argument behind this proposal is the introduction of new functionalities in the National Health Information System, which will allow centralized access to information. However, the preparation of the necessary documents for children and students required under certain circumstances will be preserved.
The proposals also emphasize the improvement of communication related to immunizations. It is envisaged to refine the way of planning and notifying persons subject to immunization, by providing various options for notification, including through a licensed postal operator, fax, electronic address or SMS.
Precision is also provided in specialized outpatient care in the medical specialty "Clinical Allergology", by specifying the requirement for consultation before immunization for persons with allergies to a vaccine component. At the same time, in the package of activities by the specialty "Obstetrics and Gynecology" is added the activity "Prevention of sexually transmitted infections" and taking material for molecular examination, related to the conduct of a PCR test for human papillomavirus, chlamydia, etc.
Significant attention is paid to the development of nuclear medicine.
It is proposed to create two new outpatient procedures that will regulate the conduct of radionuclide therapy with theranostic radiopharmaceuticals in patients with prostate carcinoma and neuroendocrine tumors. The goal is to standardize medical regulation, reduce hospitalizations, optimize costs, and ensure easier access to modern treatment.
In hospital care, the introduction of a new clinical pathway for "Transient Ischemic Attack" is planned.
The reason is the reporting of cases that do not meet the criteria for ischemic stroke, but have been treated in the clinical pathway for stroke. This leads to inaccuracies in the statistics and puts the country in a leading position in Europe in terms of stroke.
The creation of a clinical pathway for "Treatment of infections of the genitourinary system", covering urology, surgery and pediatric surgery, is another proposed change. Urinary tract infections are common and can lead to serious complications if not treated in a timely manner.
In addition, it is planned to provide the possibility of dispensary monitoring of patients with migraine by a doctor with an acquired specialty in nervous diseases. The goal is early therapy, limiting the side effects of long-term medication, and reducing treatment costs.
For patients with non-insulin-dependent diabetes mellitus, a change in the criteria for referral to an endocrinologist specialist is proposed. Consultation is provided for values of glycated hemoglobin ≥7.5%, instead of the current >8%. The goal is to improve the control of the disease and reduce the risk of complications.