Healthcare In Bulgaria Research Articles

Health services consumption and barriers in the health care of persons of Roma origin in Bulgaria

Abstract Introduction Persons of Roma origin often face serious inequities concerning their state of health and their access to good quality health services. The aim of the study is to analyze the health services consumption and barriers in the health care of persons of Roma origin in Bulgaria. Methods The cross-sectional study was conducted and a semi-structured face to face interview were applied in 2022. Adult citizens of Roma origin were covered as follows: residents of Knezha - a total of 59 people and households from the towns of Knezha and Kotel - 18 families (50 persons). The cities are representative of settlements of medium size with separate neighborhoods of Roma origin. Data processing was performed by SPSS v.24. Results Over two thirds of the covered persons of Roma origin do not have health insurance. In each household an average of 1.8 uninsured people was found, but in some of the families almost all of the elderly members are not insured. Due to lack of health insurance in 14% of the households were reported a refusal to provide health care by general practitioners (GPs) and specialists in out-hospital care. 82.1% of Roma women have never had a mammography and 71.4% a smear test. In 83.3% of the households required direct payment for the provision of health services, which corresponds to the high share of informal payments in health care in Bulgaria (34 % in 2023), but among the Roma population this share is significantly higher. The households have to pay for specialized out-hospital care (66.6%), GPs (22.2%), and for emergency assistance (5,6%). 44.4% of the families have used the services of emergency care in the last one year. While in one third of the families an adult member was hospitalized in 27.8% of them there is a need for hospital treatment, which is unrealized. Conclusions The Roma population in Bulgaria is characterized by an unfavorable health profile and the health services provided to the persons of Roma origin are inadequate to their needs. Key messages • Persons of Roma origin in Bulgaria often face serious inequities concerning their state of health and their access to good quality health services. • Improving the socioeconomic status of people of Roma origin will increase their opportunities for health insurance and going to improve their access to health services.

Strategies for Healthcare Disaster Management in the Context of Technology Innovation: the Case of Bulgaria

In Bulgaria, integrating technology and innovation is crucial for advancing sustainable healthcare disaster management, enhancing disaster response and recovery, and minimizing long-term environmental and social impacts. The purpose of the study is to assess the impact of modern technological innovations on the effectiveness of disaster management in health care in Bulgaria with a focus on Health Information Systems (HIS), Telemedicine, Telehealth, e-Health, Electronic Health Records, Artificial Intelligence (AI), Public Communication Platforms, and Data Security and Privacy. These innovations, when integrated effectively, can significantly strengthen Bulgaria's preparedness and response capabilities, improving efficiency and reducing the environmental footprint of disaster interventions. Collaboration with technology experts, research institutions, and international organizations is essential for successful implementation. The research aims to assess how these technologies can enhance disaster management efficacy, adopting a methodical approach using Systematic Literature Reviews (SLRs). Systematic Literature Reviews (SLRs) utilize precise criteria for research selection and evaluation to reduce bias, systematically compiling and analyzing data from various studies to offer evidence-based insights. They are crucial for uncovering research gaps, indicating areas needing further exploration. Findings highlight the transformative potential of technology integration in streamlining communication, data management, and operational efficiency. The study underscores the urgent need for an integrated approach and a culture of innovation within the healthcare sector, emphasizing ongoing assessment and adaptation of technology-based strategies. While acknowledging limitations and calling for further research, the study provides valuable insights into Bulgaria's healthcare disaster management strategies and sets the stage for future investigations to refine and expand upon these strategies. It advocates for a strategic framework guiding the efficient integration of technology into disaster management, aiming for resilient and patient-centric healthcare systems.

Bulgarian bioethicists on patients’ responsibility as a basis for prioritisation in healthcare

Abstract Background Patients’ responsibility as a criterion for setting priorities in healthcare has been widely discussed in the academic literature recently while the empirical knowledge is still limited. Methods We investigated perceptions of bioethicists within the Bulgarian Association of Bioethics and Clinical ethics (BABCE) on the relevance of patient's responsibility for priority setting in Bulgarian healthcare context through focus group interview. Discussions were recorded and transcribed verbatim. Conceptually driven thematic analysis was used. Results The findings suggest that members of BABCE supported the concept of patients’ responsibility but were reluctant to the application of the life style contract as a basis for prioritization in health care. The life style contract was seen as not corresponding to Bulgarian cultural particularities. The existing similar mechanisms in the field of social assistance in our country had proved to be ineffective. The main precondition for introduction of patients’ responsibility was the building of supportive environment on the side of the society and the government. The concept of prospective responsibility was seen as more acceptable than the retrospective responsibility. The participants distinguished other dimensions of personal responsibility such as intentional damages of healthcare facilities, misuse of resources, violence towards health professionals that were considered as deleterious to the healthcare system as the life style induced diseases. Conclusions The acceptance of patients’ responsibility as a criterion for prioritization in health care in Bulgaria needs to be studied further among wider professional community and the general public. A field study in the real national conditions would contribute to the development of specific tools to deal with resource allocation issues in our context. Key messages • Prioritisation in healthcare is inevitable and patients’ responsibility could be an acceptable criterion under certain conditions. • National particularities should be studied to find the most appropriate tools to deal with resource allocation issues.

Are individual risky behaviours relevant to healthcare allocation decisions? An exploratory study

PurposeThe problematic surrounding patients' prioritization decisions are currently at the centre of political leaders' concerns. How to define whom to treat when there are not enough resources to treat everybody is the key question. This exploratory study aims to investigate the views of Bulgarian citizens regarding the relevance of the information concerning eight individual health-related behaviours in priority setting decisions: smoking, excess of alcohol, illegal drug use, overweight/obesity, speed driving, extreme sports practice, unsafe sex and overuse of internet and/or mobile devices.Design/methodology/approachData were collected through a questionnaire where 322 respondents faced hypothetical rationing dilemmas comprising option pairs of the eight risky behaviours. Descriptive statistics and non-parametric tests were performed to define the penalization of each of the risky behaviours and to test for the association between this penalization and the respondent's health habits and sociodemographic characteristics.FindingsMost respondents would refuse to grant access to healthcare based on patients' personal responsibility for the disease. Nevertheless, respondents were more willing to consider illegal drug use, excessive alcohol consumption, engagement in unsafe sex behaviours and smoking. Respondent's own interest or advantage seems to be somehow relevant in explaining the penalization of risk behaviours in priority setting.Practical implicationsThis study shows that most respondents support the lottery criterion and thus do not want to see lifestyle prioritization in action.Originality/valueThis study is the first attempt to awaken attention to the impact that personal responsibility for health may have on intergenerational access to healthcare in Bulgaria.

Trends in herbal usage – a survey study

Folk medicine is quite common for primary health care in Bulgaria, and the tradition of plant usage is of importance for the development of pharmaceutical formulations. The objective of this study was to provide up-to-date information regarding trends in herbal usage among citizens in the city of Plovdiv, Bulgaria. The study involved 114 respondents for a period of 60 calendar days in 2018. Chamomile (Matricaria recutita L.) and thyme (Thymus vulgaris L.) were the most popular plants among the respondents. The common cold is the most frequent example for seeking herbals and other botanicals. Herbal teas are most preferred when it comes to daily consumption. Answers also revealed plants used in households; reasons for herbal consumption, and opinions on common statements concerning herbal stereotypes.

The use of digital devices in the field of healthcare in Bulgaria

Abstract Background The opportunities that information and communication technologies provide in the field of healthcare are many and constantly growing. Thanks to them, consumers have access to health information, consultations and remote treatment and connection with medical centers. They help to improve health promotion activities, whose mission is to promote health as a core value. The aim of the present study is to explore the attitudes regarding the use of digital devices in the field of healthcare of Bulgarian population. Methods A direct anonymous survey was conducted among 356 respondents, randomly selected and with an average age of 38.26 ± 0.15 (110 men and 246 women). The study was conducted from October 2018 to April 2019. The data analysis was performed using the statistical software SPSS v.23.0. Results The results showed that 78.9% of respondents have used or are willing to use digital devices to search for and record health information. A statistical gender difference was found in the answer to the question of using a digital device for self-registration of information (χ2 = 28.6, P < 0.05), as women are more likely to do so. More than 75% of respondents are willing to share health information with a medical professional in real-time via the internet. Older people are more reserved and hesitant about providing health information to a state agency (66.7%). The smartphone and computer/laptop are among the most preferred digital modalities in the healthcare field, with men and younger respondents more likely to use digital devices in relation to their health (χ2=39.9, P < 0.05). Women are more critical about the use of information and communication technologies in healthcare (χ2=48.2, P < 0.05). Conclusions The present study found a positive attitude among all respondents towards the introduction of modern technologies in the healthcare field and the opportunity of remote contact with medical professionals, using personal digital devices. Key messages The opportunities that information and communication technologies provide in the field of healthcare are many and constantly growing. The aim of the present study is to explore the attitudes regarding the use of digital devices in the field of healthcare of Bulgarian population.

Costs and outcomes for individuals with psychosis prior to hospital admission and following discharge in Bulgaria.

To examine the cost of psychotic disorders in Bulgaria prior to hospital admission and following discharge from two perspectives: healthcare and societal; and to evaluate the association between the costs and the patient's characteristics. 96 individuals with psychosis experiencing psychotic exacerbation and their primary caregivers were evaluated upon the patients' hospital admission. The participants were followed up after 12months. The costs were evaluated from healthcare and societal perspective using the Client's Sociodemographic and Service Receipt Inventory (CSSRI-EU). The psychopathology, functioning, quality of life and caregiver's burden were measured using standardized instruments. The mean differences in the costs and the associations with the clinical and socio-demographic characteristics of the patients were evaluated. The healthcare costs increase from EUR 120.66 (SD = 163.85) at baseline to EUR 177.54 (SD = 136.98) at follow-up. The total cost from societal perspective are up to sixfold higher than the healthcare costs at both assessments [EUR 717.41 (SD = 402.33) and 880.40 (SD = 1592.00), respectively] and do not change significantly. A major shift in the subtypes of costs, and significant associations of the costs with the socio-demographic and clinical characteristics, were found. Psychotic disorders and psychotic exacerbations have high societal costs. The underfunding of mental healthcare in Bulgaria is at the expense of high caregivers' and societal cost. The treatment of psychotic exacerbation is effective and investment in mental healthcare for the improvement of the psychopathology, social functioning, quality of life and the burden of informal care should be viewed as a sustainable investment.

Assessing Access to Healthcare in Bulgaria

Assessing access to healthcare in a given country remains a challenging endeavor. Despite the frequent use of access as a dimension of the health system performance assessment frameworks, there is no agreed-upon set of indicators to evaluate it. This study aims to assess the access to healthcare in Bulgaria. The assessment is based on a set of the most commonly used indicators with publicly available data. Results show that timeliness and physical availability are not substantial barriers for obtaining health services in Bulgaria, as the values for most of the considered indicators are better than the EU average. The most significant barrier to access to healthcare in Bulgaria is the financial affordability. Data shows insufficient financial protection alongside other factors resulting in higher than the EU average level of unmet needs due to financial reasons. Policy measures focused on decreasing the share of private health expenditures ought to be exerted to reduce inequalities in access to healthcare services.

The role of the Catholic Church in the German health system

This article examines the role of the Roman Catholic Church in the establishment of the health care system in Europe, incl. Germany. The priority, however, is focused on the role of the Roman Catholic Church in the health care system of Germany nowadays. The author has presented an area that is barely known for the Bulgarian health specialists - the system and effectiveness of the Catholic hospitals and of other Catholic structures in Germany. The author knows the system very well, due to the fact that he works in different fields of the system since 2005. The represented German experience could be useful for the specialists of the system of health care in Bulgaria.

From feldschers to physician assistants in Bulgaria.

The physician assistant (PA) profession was established in Bulgaria in 2014 in response to a growing shortage of medical staff and was modeled on the United States experience. Feldschers provided a similar role in Bulgaria from 1878 to 1999 but feldscher training was discontinued in 1999 because of a physician surplus. However, healthcare in Bulgaria changed after the country joined the European Union, and some physicians left for better opportunities elsewhere. The loss of physicians and an aging population meant that PAs were seen as a strategy to offset Bulgaria's growing healthcare demand.

Citizen participation in healthcare in Bulgaria: the gap between citizens, health experts, and local officials

PURPOSE: To investigate the views of the different stakeholders about the citizen involvement in healthcare decision-making on the local level in Bulgaria. MATERIAL AND METHODS: Opinion poll in three Bulgarian municipalities with different demographic, socio-economic, geographic and ethnic profiles was carried out. Representatives from three groups (citizens, municipality officials and health experts) took part in personal interviews. RESULTS: There was a significant difference (p<0.0001) in the opinion among the three groups about the citizen role in the healthcare decision-making in the municipalities, the availability of information and opportunities for citizen participation, and the consideration of the citizen's views by municipal decision makers. The experts and the municipal officials would like that citizen played a more prominent role in the healthcare decision-making in contrast to citizen's opinion. More than 60% of the municipal officials thought that the citizens are informed, have possibilities for participation and views considered by the municipal decision-makers while the majority of the health experts and citizens had the opposite opinion. CONCLUSION: There were significant opinion gaps between the groups about the healthcare decision-making in the three Bulgarian municipalities. Bridging the gaps required not only proper information or possibilities for participation but also motivated citizens by mutual respect, openness and better understanding of the benefits and values of citizen's involvement in public health. Scripta Scientifica Medica 2013; 45(3): 82-85.

Current healthcare in Bulgaria: time for predictive diagnostics and preventive medicine

Since 1990 Bulgaria gradually moved from monopolistic to market regulated economy and healthcare. In 2007 the country became member of the European Union and started to adopt EU legislations. However, significant gaps between the average European and Bulgarian level of social, health and economic efficiency remain to be narrowed. The major challenge is the demographic situation, where recent trends give alarming signals. Plans for reformation include transition towards out-patient palliative healthcare centers for the aging population as well as reduction of the costs with new electronic system of health insurance. The favorable location of the country at the Black Sea coast gives opportunities for medical tourism, which can provide quality health service for foreign customers. Finally, national platforms on prevention of major non-communicable diseases, such as obesity, cancer and diabetes, must be established as coordinated actions for the health and wellness of next generations.

Immigrants and healthcare in Bulgaria: the responses by policy and legislation

The global scale of international migration flows has pushed migrants’ health issues high up the policy agenda as worldwide. Bulgaria as a new EU member-state is increasingly affected by immigration pressure. The health of migrants is acknowledged as an issue of major public health importance and a challenge for policy responses. The study aims to explore the existence of specific legislative regulations and policies developed in response to immigrants’ health and healthcare services in Bulgaria, to identify the main problems and to highlight the challenges to both law and related policies. The methods involve comprehensive review and documentary analysis of international and national migrants’ health literature; analysis of regulatory norms, specific policies and practices to assess the situation of immigrants’ healthcare legislation and policy responses in the new context of Bulgaria’s EU membership. The results reveal that legislative and multi-sectoral policy initiatives have been undertaken in Bulgaria to assure the protection of immigrants’ health, never the less, there are problems emerging in practice, related to: deteriorated immigrants’ health status; absence of consistent migration-management policy; lack of systematic reliable data, health in formation and rigorous research; insufficient inter agency and international cooperation; lack of publicity and information about health insurance rights and obligations of immigrants and existing services; insufficient sensitivity and training of health professionals and relevant stake holders. Promoting migrant-sensitive health policies; sensitizing and training health service providers and relevant policy-makers and stake holders; encouraging research and information dissemination; increasing multi-sectoral involvement and expanding international cooperation on migrants’ health are actions of recognized importance to better deal with immigrants’ health problems in Bulgaria. Scripta Scientifica Medica 2009; 41(1): 69-73.

Consultation–liaison psychiatry and psychosomatic medicine in the Republic of Bulgaria

After the fall of the iron curtain in 1989, the Republic of Bulgaria has quickly developed and became a member of the European Union in 2007. Until recently the main way of providing psychiatric healthcare in Bulgaria was the “institutional model” of dispensaries and hospitals with a few outpatient clinics. The National Politic for Mental Health in the Republic of Bulgaria 2004–2012 is the main tool for developing modern psychiatric care. Its fundamental priorities are to ensure equal access to psychiatric care, to create a system of services for people with psychiatric problems and social dysfunction, to form strategies for prevention, and to promote mental health and a campaign against psychiatric stigmatization and discrimination [1]. Psychiatric disorders in somatically ill people have been treated in general hospital wards for the past four decades where specially prepared rooms were used to maintain the security of the sick. The attempts at treating these patients in psychiatric wards resulted in unfortunate complications and fatalities from physical illness due, in part, to lack of laboratory equipment. The increase of psychiatrically ill people with physical comorbidity and the complex needs of their treatment led in the 1950s to the formation of a special outpatient unit (“consulting room”) for border states of psychiatrywith internalmedicine in theNational Institute of Neurology, Psychiatry, and Neurosurgery. The specialists in internal medicine participated as cotherapists in the treatment of somatic disorders of mentally ill patients. Since 1980, the “consulting room” has conducted many research activities, as well as clinical work [2]. In recent years, the psychiatric departments of the Medical Universities of Sofia, Plovdiv, and Varna have been particularly active in teaching and research work.

On the inequitable impact of universal health insurance: The experience of Bulgaria in transition

This article deals with the social democratic aspiration of equitable access to health care in Bulgaria, a country in transition since 1989 from communism and a command economy to democracy and a free market. The focus is on access to health services and resources after the introduction of a universal health insurance system, with particular reference to formal and informal out-of-pocket payments for health care. The paper reports empirical results from a national household expenditure survey, supplemented with a semi-structured interview, conducted at the end of the survey period (April-May 2002). The results bring to light the groups in society who suffer most in this scenario: the poor, Roma, older persons and those living in towns and villages. The study reveals that the stated aim of the National Health Insurance Fund, to provide equitable access to health care, is a mirage rather than a reality, as the vast bulk of health care is self funded. This paper has particular significance for understanding the challenges faced by post-communiststates in their attempts to achieve social democratic health care reforms.

Listening & learning. Fostering health care in Bulgaria.

Linda Phillips, RN, MSN, is a nurse practitioner with Community Health Care in north central Wisconsin, doing urgent care and family practice. She served in medical missions for three years in Zambia, Africa, and four years in Eastern Europe. She attends Christ Lutheran Church in Abbotsford, Wisconsin, and volunteers with the Green Bay Mission Support Group.Figure

Mental Health Care in Bulgaria since World War II

The beginnings of mental health care in Bulgaria go back a very long time; but systematic, planned, and multifaceted development did not occur until after World War II. For the People's Republic of Bulgaria, this has been a period of fundamental change in the state and the social system. At the outset of the period under discussion, Bulgaria was in a very inauspicious situation with regard to care of the mentally ill. At the time, care by the state was limited to a single university neuropsychiatrie clinic and a few hospitals and hospices for the chronically ill, with a total of 1,135 beds (150 of which were in the university neuropsychiatrie clinic). The two disciplines neurology and psychiatry were not separated, as they are now. All told, there were only about forty doctors throughout the entire country who were working in these two areas of specialization during the war. Care in the private sector took place in only three private hospitals with fewer than a hundred beds. Outpatient care by the state was provided mainly in the university clinic in Sofia; there were a few facilities in other cities, where such care was predominantly part of private practice. The quality of care before and during the war was very unsatisfactory, and in some hospitals this continued to be the case in the early postwar years as well. Gradually, with much effort and in parallel with the development of a single, integral state network encompassing the entire country, the conditions of hospitalization, medical care in hospitals, follow-up care, and rehabilitation have steadily improved. In a number of places, hospital care has now reached optimal levels; in a few cases, it has even achieved quite comfortable conditions (e.g., in the cities of Radnevo, Varna, and others). Most of the older psychiatric hospitals were located in whatever buildings were available (monasteries, schools, and even former prisons); hence, conditions for the patients confined therein were bound to be unsatisfactory. In some