Bulgaria : Improving Quality and Sustainability of the Health System
Bulgaria has undertaken several significant health sector reforms during the past decade, but a large unfinished policy agenda remains. Compared to other EU countries, the share of out-of-pocket spending is significantly higher in Bulgaria, while...
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| Language: | English en_US |
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Washington, DC
2013
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| Online Access: | http://documents.worldbank.org/curated/en/2009/09/16280970/bulgaria-improving-quality-sustainability-health-system http://hdl.handle.net/10986/12541 |
| Summary: | Bulgaria has undertaken several
significant health sector reforms during the past decade,
but a large unfinished policy agenda remains. Compared to
other EU countries, the share of out-of-pocket spending is
significantly higher in Bulgaria, while government spending
on health is relatively low. Various indicators of reported
public satisfaction with the health system in Bulgaria are
frequently the lowest in the EU. The hospital sector has
seen rapid growth in recent years, putting the
sustainability of the system in doubt and crowding out
expenditures on more pressing priorities such as primary
health care and the reimbursement of cost-effective drugs.
Contrary to the imperative of improving health system
efficiency, in recent years the Bulgarian hospital sector
has grown in number of facilities, total number of
hospitalizations, and the budget share dedicated to
inpatient services. Each of these indicators is out of line
with European standards. The primary health care system is
well established but does not live up to its potential to
provide efficient, high-quality care. Spending on primary
health care is low, referral rates to higher levels of care
are excessive, and the payment method does not provide
adequate incentives for improved service provision. New
by-laws on pharmaceutical policy and a new positive drug
list mark a step forward, but important risks remain. The
new drug list includes many new and expensive drugs, but the
previous practice of using waiting lists to ration drug
access in response to fixed budgets is no longer being
implemented. As a result the new drug list poses a threat
to the NHIF drug budget in 2009 which was originally
programmed to be flat. The future direction of the national
health insurance system needs to be clarified with reference
to the key lessons emerging from the broad international
experience with insurance system reform. In the short-term,
protect health spending to mitigate the impact on the poor;
and stabilize the drug budget during the final months of
2009, for example by considering a re-introduction of
waiting lists for certain high-cost drugs and ensuring that
adequate funds are available for nationally procured drugs.
In the medium-term, initiate hospital sector restructuring
in line with the master plan; and consider changing the
financial incentives for hospitals, for example by enabling
the NHIF to selectively contract with hospitals and to
determine their budgets on the basis of case mix and
projected service volume using the more accurate
diagnosis-related groups (DRGs) instead of the current
Clinical Care Pathways(CCPs); Focus on measures to improve
the quality of services provided by strengthening the
instruments of licensing and accreditation, for example
through the establishment of an independent entity
responsible for these functions; creating a link between
hospital payment and information about the quality of their
services; and reviewing the Clinical Care Pathways in light
of up to date, international evidence on cost effective
treatment protocols. |
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