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health care reform and inequality of access to health care in bulgaria
Datzova, Bistra
Datzova, Bistra
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datzova2.pdf
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"The socio-political changes that have taken place in Bulgaria since 1989 have had a big impact on the health care system. The previous communist model of health care had offered universal and free access to full range of health care services and the sole funder and provider of health care was the central government. Informal payments by patients for health care services and medicines were common in Bulgaria, although not officially sanctioned by the authorities. All this led to constant crises in connection with the delivery of health care and this required radical reform to be implemented. The Bulgarian Government’s strategy includes the reform of the health sector as part of the social protection systems. The aim is to enhance sector efficiency, increase resources allocated to the health sector by tapping alternative sources of financing, and target public resources to the most cost-effective interventions. A new law on health insurance was passed by the Bulgarian Parliament in June 1998. Initially, this law provided for the collection of insurance premiums to commence on July 1, 1999, and for the health insurance financing to begin operations by January 1, 2000 for ambulatory care services and by January 1, 2001 for hospital services. Collection of premiums started as scheduled. However, later in the year the Bulgarian Government decided to postpone the effective start of the reform by 6 months - July 1, 2000 for ambulatory care, and moving to July 1, 2001 for hospital services. In connection with the above, a National Health Insurance Fund (NHIF) was also established. Modifications to the premium rates for social security and unemployment insurance have been made to provide the fiscal room for the introduction of the health insurance premiums. The compulsory health insurance is a system for social and health protection of the population, which guarantees a package of health-related services, and is administered by the NHIF and carried out by the 28 Regional Health Insurance Funds. Voluntary health insurance is optional and is carried out by limited liability companies, registered according to the Commercial Law. The Health Insurance Act also regulates the signing of the National Framework Contract between the NHIF and the professional associations of health care providers - doctors and dentists. The National Framework Contract provides for the parameters and procedures related to the functioning of the health insurance system as a whole. It defines the order, the contents and the payment of the health care activities and services to be provided to the insured population. The National Framework Contract is valid for one year, until the signing of the next one. The first National Framework Contract was signed on 27 April 2000."(pg 3)
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2003-09
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With permission of the license/copyright holder