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Prospects and Characteristics of The Health Reform in Bulgaria
The International Business Club gathered diplomatic missions' and international organizations' representatives, foreign and local medical companies and experts at a business meeting on "Characteristics and Prospects of the Health Reform in Bulgaria" with the Minister of Health Dr. Ilko Semerdzhiev, and Ms. Lada Stoyanova, the World Bank Deputy Resident Representative. Mr. Jaroslav Lindenberg, Ambassador of Poland, Ms. Nilima Mitra, Ambassador of India, Dr. Boyko Penkov and Dr. Boyan Doganov from the National Health Insurance Company attended the meeting, held on July 7, 2000 at the Center for the Study of Democracy.

Minister Semerdzhiev introduced the participants with the characteristics and the problems of the health reform in this country, launched on July 1, 2000. He pointed out the ineffective attempts of previous governments, which resulted in low health indicators, useless health structures and inappropriate financing and payment system. It was only in 1997, when a new approach was applied in reforming the legal framework and the system's management. The outdated Public Health Act of 1972 was replaced by seven new laws, allowing the Bulgarian health insurance system to pass from an integrated model to a contract based one for regulating the doctors-patients relations.

The presentation of Dr. Semerdzhiev focused on the following trends:

Financing of the sector, as stipulated in the Health Insurance Act, will be implemented not only through taxes and fees, but through health insurance and additional payments as well. Tax revenues will finance only emergency and psychiatric medical attendance, scientific research and some other activities. Doctors, entering contracts based relations with patients, will not be reimbursed by the state any more.

Transforming state hospitals into commercial and limited liability companies, as stipulated in the Medical Institutions Act, will impact the status of these entities as well. This will provide opportunities for changing the hospitals' ownership in view of their further privatization. During the last six months more than 17,000 legal entities of this type have been registered. Reform in the medical education and training area; Reform in the legal status and the management of the health system resources.

The reform is targeted at providing security of the individuals' and public health care and access to health services of improved quality. It will redirect priorities by accentuating on the patient's health rather than on the disease itself, by funding health activities than health structures, by applying decentralization and contract based management than administering the process.

Further Ms. Lada Stoyanova, WB Mission Deputy Representative outlined the joint project for rendering support to the Government in its efforts to implement the health reform. The Bank is currently engaged in a 0 worth Project of five-year period, targeted at establishing a cheap and secure health system and a guaranteed access to all types of health services

The project consists of four major components:
  • basic health care improvement;
  • hospital services improvement;
  • health security system improvement, and
  • Staff training.

  • After the project's completion the Government is expected to establish an effective, cheap and stable health care system to acquire lower administrative costs regardless the patients' social status, equal access to good quality services regardless the amounts paid, offering medical care for socially weak, aged and remotely located strata of the population, as well as improving the doctors' working conditions.

    Ms. Stoyanova emphasized that the Project, which is worked out jointly by the governments of Switzerland and Bulgaria and the WB, is a wonderful example for the cooperation between donors. USAID also has launched a health project of its own, while coordinating its intentions and efforts with WB.

    During the discussion the participants were interested in the public attitude to the health reform, the guarantee for proper access to medical services, the contents of the medical package, the opportunities for offering medical treatment to foreign citizens and diplomats, etc. Minister Semerdzhiev and Dr. Boyko Penkov emphasized that changes are accepted inconsistently by society, however due to the doctors' training program problems are overcome more easily.

    All members of society will be provided with an equal access as stipulated in their medical contracts with doctors, while foreign diplomats will be offered services free of charge. The reform will improve conditions in the hospitals and even more foreigners will be treated in Bulgaria in the years to come
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