PATIENTS’ AND PHYSICIANS’ OPINION ON HEALTHCARE REFORM IN BULGARIA

Abstract

BACKGROUND. Bulgarian health system is undergoing fundamental organizational changes started since 1998 with the adoption of three new fundamental laws - Health Insurance Act (1998), Health Care Establishments Act (1999) and Law for professional organizations of physicians and dentists (1998). The new legislation laid the foundations of radical transformation of financing and delivery of health services to the population with introduction of market mechanisms for resource management. The aim of this paper is to analyse the acceptance and critical evaluation of Bulgarian health reform based on patients’ and physicians’ opinion. METHODS. The study was carried out in 2010 in 9 randomly selected urban regional centres. From 18 outpatient medical centres and 11 hospitals the samples of 1863 patients and 718 physicians were chosen by convenience. The data were collected by self-administered questionnaire of 26 open-ended questions encompassing identification data, questions about awareness, expectations, acceptance and satisfaction with different aspects of health reform. RESULTS. Significant differences in responses concerning the information and awareness on main aspects of health reform were found in favour of physicians and low level of knowledge for patients. Both groups demonstrated unrealistic and maximalist over expectations for rapid and large increase in the quality of medical services significantly higher in the group of physicians except for the physicians’ wages. Much lower were the expectations about the negative effects that really occurred during the process of reform. Conclusions. Significant unawareness on various aspects of reform was demonstrated among respondents more explicit in the group of patients. The phenomenon of information asymmetry is the leading factor for the failure of health reform and serious changes should be undertaken to increase the public and professional acceptance and satisfaction of the health reform. Keywords: Bulgaria, healthcare reform, patients’ opinion, physicians’ opinion, information asymmetry