Article

Public attitudes towards patient payments in Bulgarian public health care sector: results of a household survey.

Department of Health Organization, Policy and Economics, Faculty of Health Sciences, University of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.
Health Policy (impact factor: 1.51). 02/2002; 59(1):1-24. pp.1-24
Source: PubMed

ABSTRACT This paper analyses the attitudes towards patient payments in the Bulgarian public health care sector. The analysis is based on results of a household survey conducted in the region of Varna (the third largest city in Bulgaria) between May and June 2000. The data are collected through interviews based on a standardised questionnaire and are analysed by non-parametric statistical procedures. The results show that the majority of the respondents accept to pay for public health care services if these services are provided with good quality and quick access. On average, charges for primary and dental care receive higher approval than charges for hospital services. A large percentage of the sample disagrees with charges related to actual service cost or service quality and nearly all respondents consider a ceiling on payments appropriate. According to the majority of the interviewed, the charges should be retained at the place of service provision. The sample shows strong support for an extensive system of exemptions from payments.

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    Article: Regulatory barriers to equity in a health system in transition: a qualitative study in Bulgaria.
    Boika Rechel, Clare M Blackburn, Nick J Spencer, Bernd Rechel
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    ABSTRACT: Health reforms in Bulgaria have introduced major changes to the financing, delivery and regulation of health care. As in many other countries of Central and Eastern Europe, these included introducing general practice, establishing a health insurance system, reorganizing hospital services, and setting up new payment mechanisms for providers, including patient co-payments. Our study explored perceptions of regulatory barriers to equity in Bulgarian child health services. 50 qualitative in-depth interviews with users, providers and policy-makers concerned with child health services in Bulgaria, conducted in two villages, one town of 70,000 inhabitants, and the capital Sofia. The participants in our study reported a variety of regulatory barriers which undermined the principles of equity and, as far as the health insurance system is concerned, solidarity. These included non-participation in the compulsory health insurance system, informal payments, and charging user fees to exempted patients. The participants also reported seemingly unnecessary treatments in the growing private sector. These regulatory failures were associated with the fast pace of reforms, lack of consultation, inadequate public financing of the health system, a perceived "commercialization" of medicine, and weak enforcement of legislation. A recurrent theme from the interviews was the need for better information about patient rights and services covered by the health insurance system. Regulatory barriers to equity and compliance in daily practice deserve more attention from policy-makers when embarking on health reforms. New financing sources and an increasing role of the private sector need to be accompanied by an appropriate and enforceable regulatory framework to control the behavior of health care providers and ensure equity in access to health services.
    BMC Health Services Research 09/2011; 11:219. · 1.66 Impact Factor
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Keywords

analysed
 
Bulgaria
 
Bulgarian public health care sector
 
charges
 
extensive system
 
good quality
 
higher approval
 
household survey
 
interviews
 
large percentage
 
non-parametric statistical procedures
 
paper analyses
 
patient payments
 
public health care services
 
quick access
 
service provision
 
service quality
 
strong support
 
third largest city
 
Varna
 

Milena Pavlova