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Book ; Online: Can people afford to pay for health care? New evidence on financial protection in Bulgaria

Dimova, Antoniya / García-Ramírez, Jorge Alejandro

2021

Abstract: xiv, 78 p. ... This review is part of a series of country-based studies generating new evidence on financial protection in European health systems. Financial protection is central to universal health coverage and a core dimension of health system ... ...

Abstract	xiv, 78 p. This review is part of a series of country-based studies generating new evidence on financial protection in European health systems. Financial protection is central to universal health coverage and a core dimension of health system performance. Bulgaria has a high incidence of impoverishing and catastrophic health spending compared to other countries in Europe. Catastrophic spending is almost entirely driven by out-of-pocket payments for outpatient medicines and has increased over time. It is heavily concentrated among poorer households, older people and people living in rural areas, reflecting significant gaps in all three dimensions of health coverage: population entitlement, service coverage and user charges (co-payments). Although public spending on health has grown in recent years, it remains low by European Union standards and has not kept pace with growth in out-of-pocket payments or been used to target unmet need and financial hardship. To reduce unmet need and financial hardship, the Government should focus on improving the affordability of outpatient medicines and strengthening protection from out-of-pocket payments for poorer households and people with chronic conditions. This can be done by: introducing exemptions from co-payments for these two groups of people; extending the annual cap on co-payments for inpatient care to all co-payments and linking the cap to household income; continuing to improve the way in which the National Health Insurance Fund purchases outpatient medicines; and finding ways to extend health insurance to the whole population.
Keywords	Bulgaria ; Healthcare Financing ; Health Services Accessibility ; Financing ; Personal ; Poverty ; Universal Health Insurance
Language	English
Publisher	World Health Organization. Regional Office for Europe
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: An innovative approach to participatory health policy development in Bulgaria: The conception and first achievements of the Partnership for Health.

Dimova, Antoniya / Rohova, Maria / Hasardzhiev, Stanimir / Spranger, Anne

Health policy (Amsterdam, Netherlands)

2017 Volume 122, Issue 2, Page(s) 81–86

Abstract: The Bulgarian Partnership for Health was established in 2015 as a new forum for health policy formulation and discussion. The Partnership presents a new approach of structured and sustained stakeholder involvement to overcome the lack of public ... ...

Abstract	The Bulgarian Partnership for Health was established in 2015 as a new forum for health policy formulation and discussion. The Partnership presents a new approach of structured and sustained stakeholder involvement to overcome the lack of public participation in health policy development and implementation. Constituted as a permanent consultative body to the Council of Ministers, the Partnership engages a wide variety of stakeholders and professionals to shape and improve health policies. The shared governance of the Partnership between the Minister of Health and a patient organisation supports the elaboration of legislative acts based on the stakeholders' collaboration in priority areas. The governance and organisational structure of the Partnership assures capacity building, fast mobilisation of experts, continuity of stakeholder involvement, and increased responsibility in health policy development and implementation. This type of participatory approach may help reconcile initially opposing positions and foster reforms often impeded by political antagonism. Persisting challenges are a rather slow process of policy development and different perceptions of key concepts among the stakeholders. As policy-making in many countries in Eastern Europe suffers from political distrust, the Partnership's approach of involving experts - and not only politicians - could provide inspiration also to other countries, which have struggled with inconsistency of health policies pursued by different governments.
MeSH term(s)	Bulgaria ; Community Participation/methods ; Cooperative Behavior ; Government ; Health Policy ; Humans ; Policy Making ; Public Opinion
Language	English
Publishing date	2017-11-11
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605805-x
ISSN	1872-6054 ; 0168-8510
ISSN (online)	1872-6054
ISSN	0168-8510
DOI	10.1016/j.healthpol.2017.11.002
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Article: Integrated Diabetes Care Delivered by Patients - A Case Study from Bulgaria.

Struckmann, Verena / Barbabella, Francesco / Dimova, Antoniya / van Ginneken, Ewout

International journal of integrated care

2017 Volume 17, Issue 1, Page(s) 6

Abstract: Introduction: Increasing numbers of persons are living with multiple chronic diseases and unmet medical needs in Bulgaria. The Bulgarian 'Diabetic care' non-profit (DCNPO) programme aims to provide comprehensive integrated care focusing on people with ... ...

Abstract	Introduction: Increasing numbers of persons are living with multiple chronic diseases and unmet medical needs in Bulgaria. The Bulgarian 'Diabetic care' non-profit (DCNPO) programme aims to provide comprehensive integrated care focusing on people with diabetes and their co-morbidities. Methods: The DCNPO programme was selected as one of eight 'high potential' programmes in the Innovating Care for People with Multiple Chronic Conditions (ICARE4EU) project, covering 31 European countries. Data was first gathered with a questionnaire after which semi-structured interviews with project staff and participants were conducted during a site visit. Results: The programme trains diabetic patients to act as carers, case managers, self-management trainers and health system navigators for diabetic patients and their family. The programme improved care coordination and patient-centered care by offering free care delivered by a multidisciplinary team. It facilitates the collaboration between patients, volunteers, health providers and the community. Internal evaluations demonstrate reduced hospital admissions and avoidable amputations, with consequent cost savings for the health care system. Conclusion: Integrated care provided by volunteering patients can empower people suffering from diabetes and their co-morbidities and address health and social inequalities in resource-poor settings. It can also contribute to an increased trust and improved satisfaction among vulnerable patients with complex care needs.
Language	English
Publishing date	2017-03-31
Publishing country	England
Document type	Case Reports
ISSN	1568-4156
ISSN	1568-4156
DOI	10.5334/ijic.2475
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Drug Policy in Bulgaria.

Dimova, Antoniya / Rohova, Maria / Atanasova, Elka / Kawalec, Paweł / Czok, Katarzyna

Value in health regional issues

2017 Volume 13, Page(s) 50–54

Abstract: Bulgaria has a mixed public-private health care financing system. Health care is financed mainly from compulsory health insurance contributions and out-of-pocket payments. Out-of-pocket payments constitute a large share of the total health care ... ...

Abstract	Bulgaria has a mixed public-private health care financing system. Health care is financed mainly from compulsory health insurance contributions and out-of-pocket payments. Out-of-pocket payments constitute a large share of the total health care expenditure (44.14% in 2014). The share of drugs expenditure for outpatient treatment was 42.3% of the total health care expenditure in 2014, covered mainly by private payments (78.6% of the total pharmaceutical expenditure). The drug policy is run by the Ministry of Health (MoH), the National Council on Prices and Reimbursement of Medicinal Products, and the Health Technology Assessment Commission. The MoH defines diseases for which the National Health Insurance Fund (NHIF) pays for medicines. The National Council on Prices and Reimbursement of Medicinal Products maintains a positive drug list (PDL) and sets drug prices. Health technology assessment was introduced in 2015 for medicinal products belonging to a new international nonproprietary name group. The PDL defines prescription medicines that are paid for by the NHIF, the MoH, and the health care establishments; exact patient co-payments and reimbursement levels; as well as the ceiling prices for drugs not covered by the NHIF, including over-the-counter medicines. The reimbursement level can be 100%, 75%, or up to 50%. The PDL is revised monthly in all cases except for price increase. Physicians are not assigned with pharmaceutical budgets, there is a brand prescribing practice, and the substitution of prescribed medicines by pharmacists is prohibited. Policies toward cost containment and effectiveness increase include introduction of a reference pricing system, obligation to the NHIF to conduct mandatory centralized bargaining of discounts for medicinal products included in the PDL, public tendering for medicines for hospital treatment, reduction of markup margins of wholesalers and retailers, patient co-payment, and the introduction of health technology assessment. Although most of the policies have been introduced since 2011, there is still weak evidence for improvement regarding cost containment and effectiveness.
MeSH term(s)	Bulgaria ; Commerce ; Delivery of Health Care ; Drug Costs ; Economics, Pharmaceutical ; Government Regulation ; Health Expenditures ; Health Policy ; Humans ; National Health Programs/economics ; Reimbursement Mechanisms/economics ; Technology Assessment, Biomedical
Language	English
Publishing date	2017-09-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2679127-4
ISSN	2212-1102 ; 2212-1099
ISSN (online)	2212-1102
ISSN	2212-1099
DOI	10.1016/j.vhri.2017.08.001
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Article ; Online: A comparison of health system responses to COVID-19 in Bulgaria, Croatia and Romania in 2020.

Džakula, Aleksandar / Banadinović, Maja / Lovrenčić, Iva Lukačević / Vajagić, Maja / Dimova, Antoniya / Rohova, Maria / Minev, Mincho / Scintee, Silvia Gabriela / Vladescu, Cristian / Farcasanu, Dana / Robinson, Susannah / Spranger, Anne / Sagan, Anna / Rechel, Bernd

Health policy (Amsterdam, Netherlands)

2022 Volume 126, Issue 5, Page(s) 456–464

Abstract: This article compares the health system responses to COVID-19 in Bulgaria, Croatia and Romania from February 2020 until the end of 2020. It explores similarities and differences between the three countries, building primarily on the methodology and ... ...

Abstract	This article compares the health system responses to COVID-19 in Bulgaria, Croatia and Romania from February 2020 until the end of 2020. It explores similarities and differences between the three countries, building primarily on the methodology and content compiled in the COVID-19 Health System Response Monitor (HSRM). We find that all three countries entered the COVID-19 crisis with common problems, including workforce shortages and underdeveloped and underutilized preventive and primary care. The countries reacted swiftly to the first wave of the COVID-19 pandemic, declaring a state of emergency in March 2020 and setting up new governance mechanisms. The initial response benefited from a centralized approach and high levels of public trust but proved to be only a short-term solution. Over time, governance became dominated by political and economic considerations, communication to the public became contradictory, and levels of public trust declined dramatically. The three countries created additional bed capacity for the treatment of COVID-19 patients in the first wave, but a greater challenge was to ensure a sufficient supply of qualified health workers. New digital and remote tools for the provision of non-COVID-19 health services were introduced or used more widely, with an increase in telephone or online consultations and a simplification of administrative procedures. However, the provision and uptake of non-COVID-19 health services was still affected negatively by the pandemic. Overall, the COVID-19 pandemic has exposed pre-existing health system and governance challenges in the three countries, leading to a large number of preventable deaths.
MeSH term(s)	Bulgaria/epidemiology ; COVID-19 ; Croatia/epidemiology ; Humans ; Pandemics ; Romania/epidemiology ; SARS-CoV-2
Language	English
Publishing date	2022-02-17
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	605805-x
ISSN	1872-6054 ; 0168-8510
ISSN (online)	1872-6054
ISSN	0168-8510
DOI	10.1016/j.healthpol.2022.02.003
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Book: Bulgaria

Atanasova, Elka / Dimova, Antoniya / Koeva, Stefka / Moutafova, Emanuela / Rohova, Maria

health system review

(Health systems in transition ; 14.2012,3)

2012

Author's details	Antoniya Dimova; Maria Rohova; Emanuela Moutafova; Elka Atanasova; Stefka Koeva
Series title	Health systems in transition ; 14.2012,3
Keywords	Gesundheitswesen ; Bulgarien
Language	English
Size	XX, 186 S., graph. Darst., Kt.
Publisher	WHO Regional Off. for Europe
Publishing place	Copenhagen
Document type	Book
Database	ECONomics Information System

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Article ; Online: Bulgaria: Health System Review.

Dimova, Antoniya / Rohova, Maria / Koeva, Stefka / Atanasova, Elka / Koeva-Dimitrova, Lubomira / Kostadinova, Todorka / Spranger, Anne

Health systems in transition

2018 Volume 20, Issue 4, Page(s) 1–230

Abstract: This analysis of the Bulgarian health system reviews developments in its organization and governance, health financing, health care provision, health reforms and health system performance. With the 2015 National Health Strategy 2020 at its core, there ... ...

Abstract	This analysis of the Bulgarian health system reviews developments in its organization and governance, health financing, health care provision, health reforms and health system performance. With the 2015 National Health Strategy 2020 at its core, there have been ambitious reform plans to introduce more decentralization, strategic purchasing and integrated care into the Bulgarian social health insurance system. However, the main characteristics of the Bulgarian health system, including a high level of centralization and a single payer to administer social health insurance, remain intact and very few reforms have been implemented (for example, the introduction of health technology assessment). There are multiple reasons for this, of which political fragility and stakeholder resistance are among the most important. Overall, Bulgaria marked notable progress on some health indicators (for example, life expectancy and infant mortality) but generally progress lags behind EU averages. What is more, the system has not been effective in reducing amenable mortality, as reflected in the unsteady improvement patterns in mortality due to malignant neoplasms. This is despite an increase in total health expenditure as a percentage of gross domestic product to 8.2% in 2015. The overall high out-of-pocket spending (47.7% of total health spending in 2015) has been growing and is increasingly worrisome. It evidences the low degree of financial protection by the Bulgarian social health insurance system and exacerbates the already considerable inequities along socioeconomic and regional fault lines. For instance, there are regional imbalances of medical professionals, which are more concentrated in urban areas, and accessibility to physicians is further deteriorating, especially in rural areas. Current reforms have to tackle these challenges and build consensus among stakeholders of the health system to unlock the standstill.
MeSH term(s)	Bulgaria ; Delivery of Health Care ; Health Policy ; Humans ; Quality of Health Care
Language	English
Publishing date	2018-11-05
Publishing country	Denmark
Document type	Journal Article ; Review
ZDB-ID	2233748-9
ISSN	1817-6127 ; 1817-6119
ISSN (online)	1817-6127
ISSN	1817-6119
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Book ; Online: Bulgaria

European Observatory on Health Systems and Policies / Dimova, Antoniya / Rohova, Maria / Koeva, Stefka / Atanasova, Elka / Koeva-Dimitrova, Lubomira / Kostadinova, Todorka / Spranger, Anne / Polin, Katherine

health system summary

2022

Abstract: 19 p. ... This Health System Summary is based on the Bulgaria: Health System Review (HiT) published in 2018 and relevant reform updates highlighted by the Health Systems and Policies Monitor (HSPM) (www.hspm.org). For this edition, key data have been ... ...

Abstract	19 p. This Health System Summary is based on the Bulgaria: Health System Review (HiT) published in 2018 and relevant reform updates highlighted by the Health Systems and Policies Monitor (HSPM) (www.hspm.org). For this edition, key data have been updated to those available in July 2022 to keep information as current as possible. Health System Summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.
Keywords	Health Systems Plans ; Delivery of Health Care ; Evaluation Studies as Topic ; Health Care Reform ; Bulgaria
Language	English
Publisher	World Health Organization. Regional Office for Europe
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Exploring variation of coverage and access to dental care for adults in 11 European countries: a vignette approach.

Winkelmann, Juliane / Gómez Rossi, Jesús / Schwendicke, Falk / Dimova, Antoniya / Atanasova, Elka / Habicht, Triin / Kasekamp, Kaija / Gandré, Coralie / Or, Zeynep / McAuliffe, Úna / Murauskiene, Liubove / Kroneman, Madelon / de Jong, Judith / Kowalska-Bobko, Iwona / Badora-Musiał, Katarzyna / Motyl, Sylwia / Figueiredo Augusto, Gonçalo / Pažitný, Peter / Kandilaki, Daniela /

Löffler, Lubica / Lundgren, Carl / Janlöv, Nils / van Ginneken, Ewout / Panteli, Dimitra

BMC oral health

2022 Volume 22, Issue 1, Page(s) 65

Abstract: Background: Oral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to ... ...

Abstract	Background: Oral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach. Methods: We used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists. Results: Completed vignettes were received from 11 countries: Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different physical barriers to accessing dental care. The limited availability of contracted dentists (especially in rural areas) and the unequal distribution and lack of specialised dentists are major access barriers to public dental care. Conclusions: According to the results, statutory coverage of dental care varies across European countries, while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries, leading to high out-of-pocket spending. Socioeconomic status is thus a main determinant for access to dental care, but other factors such as geography, age and comorbidities can also inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care.
MeSH term(s)	Adult ; Dental Care ; Europe ; Health Expenditures ; Health Services ; Health Services Accessibility ; Humans ; Oral Health
Language	English
Publishing date	2022-03-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2091511-1
ISSN	1472-6831 ; 1472-6831
ISSN (online)	1472-6831
ISSN	1472-6831
DOI	10.1186/s12903-022-02095-4
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Book: Bulgaria

Avdeeva, Olga / Dimitrova, Rostislava / Dimova, Antoniya / Georgieva, Lidia / Salchev, Petko

health system review

(Health systems in transition ; 9.2007,1)

2007

Author's details	written by Lidia Georgieva; Petko Salchev; Rostislava Dimitrova; Antoniya Dimova; Olga Avdeeva
Series title	Health systems in transition ; 9.2007,1
Keywords	Gesundheitswesen ; Bulgarien
Language	English
Size	XVIII,156 S., graph. Darst.
Publisher	WHO Regional Off. for Europe
Publishing place	Copenhagen
Document type	Book
Note	Literaturverz. S. 151 - 154
Database	ECONomics Information System

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