Access to health care in a system transition: the case of Bulgaria

Abstract

An apparent lack of inequalities in access to care conceals a more complex picture in which income and gender influence the pathways taken through the system.

What have 10 years of health insurance reforms brought about in Bulgaria? Re-appraising the Health Insurance Act of 1998

“…Moreover, patients' trust in primary health care is still low and GPs are often bypassed even though patients have to pay higher co-payments when they have no referral from a GP [10,20]. Although out-patient departments of Bulgarian hospitals are less "crowded" compared to hospitals in neighbouring countries with no referral system [20], this does not apply to the emergency departments.…”

“…Although the policy of NHIF has as its goal to decrease the price and non-price barriers for access to more and diverse health care services by insured individuals, some important inequities in health care provision remain or have emerged [10][11][12]58], which is in contrast to prior expectations (point 12 in Table 2). …”

“…This article aims to review the evidence on the outcomes of the health insurance reform in Bulgaria from the perspective of expectations and concerns at the start of the reform. Apart from some studies that analyse the separate effects of this reform, or of the Bulgarian health care reforms in general [2,[10][11][12][13][14], a review of studies that focus on the reform outcomes, is lacking. Such review could facilitate a systematic evidence-based evaluation of the Bulgarian health insurance, which emphasises the relevance of our article.…”

The importance of quality, access and price to health care consumers in Bulgaria: a self‐explicated approach

“…The absence of appropriate reforms contributed to the growing inefficiency, poor quality and incidents of inequity (e.g. Balabanova and McKee, 2002b;Borisov and Rathwell, 1996;Minev et al, 1990;McKee, 1991). Needless to say, there were not sufficient financial resources for the much-needed modernization of the health care sector.…”

Health Reforms in South East Europe: An Introduction

“…P eople increasingly preferred self-treatment at home, before visiting the local polyclinic. Access to primary health services remained egalitarian, with the probability of consulting a health professional being re l ated to age and level of illness rather than income (Balabanova and McKee 2002). However, the quality of care beyond the primary level varied with income, with the poor being treated in low quality facilities.…”