Public attitudes towards health after COVID-19 pandemic according to healthcare professionals

Introduction: The consequences of the Covid-19 pandemic in all aspects of life have affected not only the public attitudes towards health authorities and bodies, but also towards health as a basic human value.Purpose: To determine public attitudes 2 years after the start of the COVID-19 pandemic according to practicing healthcare professionals.Materials and Methods: An anonymous online survey using Google Forms was conducted in April 2022 among healthcare professionals who were students in “Management of  health care” program.Results and discussion: According to health care professionals, there is low public trust between clients and health care providers. More than 1/5 of the respondents disagreed with the statement that "Our society has realized that health is the most important value", and 10.9% hesitated and answered "neither agree nor disagree". This attitude of the pledge to health as a value after 2 (two) years in conditions of a severe pandemic, may prove to be a great obstacle in the imposition of future measures by the health authorities related to the protection of public health.Conclusion: Actions are needed on the part of the health authorities in the country to build public trust in them. Adherence to measures imposed by health authorities are key in the event of a pandemic

Enfortumab vedotin for the treatment of patients with urothelial cancer after failure of the treatment with PD-1/PD-L1 inhibitor—cost-effectiveness analysis

Introduction: Bladder cancer (BC) is one of the most common malignancies in industrialized countries. The incidence of BC increases with age and is almost 3 times more common in men than in women. The therapy in adult patients with locally advanced or metastatic BC who have previously received chemotherapy containing platinum and a PD-1/PD-L1 inhibitor requires the inclusion of enfortumab vedotin (EV) or docetaxel- or paclitaxel-based chemotherapy.Aim: The aim of the study is to model local data on long-term costs and health benefits from the application of alternative health technologies for the treatment of patients with BC to decide which therapy has an advantage in terms of the ratio of therapeutic efficacy and cost-effectiveness.Materials and Methods: Inputs in the prognostic model used were measured and evaluated as clinical endpoints in the EV-301 multicentre randomized clinical trial. The modelled data on future health benefits and costs after the end of the clinical trial are based on Markov’s model with three health conditions, one of which is absorbent.Conclusion: Despite therapeutic superiority of enfortumab vedotin over chemotherapy (docetaxel, paclitaxel), it is not a cost-effective approach to treat patients with urothelial carcinoma after failure with PD-1/PD-L1 inhibitors. The only reason for this is its high price. The value of the cost-benefit ratio of enfortumab vedotin is around BGN 659,000/QALY and significantly exceeds the cost-effectiveness threshold (ICER ≤ BGN 50,000/QALY), which is equal to three times the gross domestic product per capita of the population in Bulgaria for the previous year

DINAMICA PIEȚEI FORȚEI DE MUNCĂ ÎN BULGARIA

BACKGROUND. Bulgaria, as many countries in the world is experiencing a critical period for the health workforce. The shortage of qualified nurses is one of the biggest obstacles for improving the health-system performance. Lack of strategic planning based on profound market research and elaboration of scientifically based prognosis further deteriorate the current nursing labor market disequilibrium. THE AIM of the study is to explore the main factors influencing the nursing market disequilibrium in Bulgaria and to make an evidence-based forecast of the future needs for nurses in order to suggest relevant workforce development strategies. MATERIAL AND METHODS. The study employs a combination of sociological and statistical methods. The analysis is based on the official statistical data on Bulgarian nursing personnel up to 2012. Primary information is collected through self-administered questionnaires distributed among 337 practicing nurses from April 2007 to December 2012. Data are processed with the packages MS Office Excel 2010 and SPSS v. 13. RESULTS. Results indicate that a decrease in the demand for nursing labour caused large staff layoffs during the first stage of the restructuring period (1990-2000) followed by a severe drop in the number of nurses due to emigration and exodus from the profession. There are also educational and qualification problems along with unattractiveness of the nursing practice due to high workload and low remuneration. With the mean age of 49 severe nursing workforce’s deficit is expected in 10-15 years due to retirement. According to our estimations the deficit of nurses will account for 3162 specialists by 2030. CONCLUSION. The Bulgarian nursing labor market disequilibrium is due to long-term structural imbalances. As the market mechanism is unable to attain equilibrium Bulgarian government should be urgently involved in workforce planning and initiate actions and strategies for producing and retaining the highly qualified nurse professionals in Bulgaria.   Key words: nursing workforce market, Bulgaria, disequilibrium, factors.  CONTEXT. Similar multor state, Bulgaria traversează, de asemenea, o perioadă critică în ceea ce privește piața forței de muncă din sănătate. Lipsa de asistente medicale calificate este unul dintre cele mai mari obstacole pentru îmbunătățirea performanței sistemului de sănătate. Lipsa planificării strategice bazată pe cercetare amănunțită a pieței și lipsa prognozelor și proiecțiilor bazate pe argumente științifice conduc la dezechilibrul existent pe piața muncii asistentelor medicale, existent la momentul actual. SCOPUL studiului este de a explora factorii principali care influențează dezechilibrul de pe piața muncii asistentelor medicale în Bulgaria și de a face prognoze, bazate pe dovezi, ale nevoilor viitoare de asistente medicale, în scopul de a sugera strategii viitoare de dezvoltare a forței de muncă. MATERIAL ȘI METODE. Studiul  de față abordează o combinație de metode sociologice și statistice.  Analiza are la bază date statistice oficiale privind personalul medical din Bulgaria, date disponibile inclusiv pentru anul 2012. Informatiile primare au fost colectate cu ajutorul unor chestionare auto-administrate, distribuite unui număr de 337 asistente medicale practicante, în perioada aprilie 2007 - decembrie 2012. Datele sunt prelucrate cu pachetele de analiză MS Office Excel 2010 și SPSS v. 13. REZULTATE. Rezultatele indică faptul că scăderea cererii pentru asistentele medicale a cauzat  disponibilizările masive din timpul primei etape a perioadei de restructurare 1990-2000, urmată de o scădere severă a numărului de asistente medicale din cauza emigrării și exodul profesional. Există probleme educațiomale și de calificare, alături de lipsa de atractivitate a practicii de asistentă medicală din cauza volumului mare de muncă și a nivelului redus de salarizare. Cu o medie crescută a vârstei asistentelor medicale, de 49 de ani,  un deficit sever este așteptat în următorii 10+15 ani, din cauza fenomenului de pensionare. Conform estimărilor noastre, deficitul de asistente medicale, până în anul 2030, va fi de 3162 de specialiști. CONCLUZII. Dezechilibrul numeric de asistente medicale de pe piața forței de muncă din sănătate este cauza unor dezechilibre structurale pe termen lung. Cum mecanismul piaței nu este în măsură să rezolve acest dezechilibru, guvernul din Bulgaria va trebui urgent să  se implice în planificarea forței de muncă și să inițieze acțiuni și strategii de creare și menținere a asistentelor medicale calificate, în Bulgaria.  Cuvinte cheie: piața forței de muncă, asistente medicale, dezechilibru, factori frenatori, Bulgaria &nbsp

CEREREA INDUSĂ LA NIVELUL SERVICIILOR SPITALICEŞTI DIN BULGARIA – TENDINŢE ACTUALE ŞI FACTORI

Background.   The aim of this paper is to explore the trends of hospitalization and to analyse the main determining factors for over-hospitalization.Methods. The analysis is based on the Annual financial reports of the National Health Insurance Fund (NHIF) in Bulgaria, the Annuals of Public Health Statistics published by the National Centre of Health Informatics, and corresponding data for European countries the European Health for All Database for the period 2000-2009.Results.   Conclusion. The main reasons for the enormous increase in hospital admissions have been mainly related to the increased induced demands for hospital services, ineffective referrals and treatment of chronic diseases in hospitals for acute diseases, patients’ mistrust to outpatient care, low efficiency of primary health care, inadequate supervision and regulation by the National Health Insurance Fund. Improper and ineffective health policy and hospital management led to consumerist attitudes in health care that contribute more to health care providers than to the patients in need.Key words: over-hospitalization, induced demand, hospital services cost, hospital management.For a period of ten years, the expenditures for hospital services have increased by 390% while the GDP has grown in real terms only by 47%. The number of hospital admissions since 2004 to 2009 has increased more than twice (from 738 978 to 1 769 230). The critical point of increase was observed between 2005 and 2006 when all the financing of hospital services was totally undertaken by the NHIF.Changing the management and financing in Bulgarian health care system after 2000 led to many new problems in organization and management of medical activities, especially in hospital care, after the adoption of the Health Care Establishments Act in 1999. Serious problems in hospital care occurred in relation to the induced demands for hospital services which contribute to over-hospitalization and overexpenditures.Context.   Scopul   Metode.   Rezultate.   Concluzii.   Cuvinte cheie:   supra-spitalizare, cerere indusă, cost, servicii spitaliceşti, managementspitalicescPrincipalele motive ale creşterii enorme a numărului de internări a fost legat, în principal, de creşterea cererii induse pentru serviciile spitaliceşti, trimiteri ineficiente şi tratarea afecţiunilor cornice în spitale pentru acuţi, neîncrederea pacienţilor în calitatea îngrijirilor ambulatorii, eficienţă scăzută a asistenţei primare, supraveghere şi reglementare necorespunzătoare din partea NHIF. Politică de sănătate şi management spitalicesc neadecvate şi ineficiente orientate mai mult spre furnizorii de servicii medicale şi mai puţin spre nevoile pacienţilor.În perioada analizată (zece ani), cheltuielile serviciilor spitaliceşti au crescut până la 390%, în timp ce PIB-ul a crescut, în valoare reală, cu doar 47%. Numărul de internări a crescut de peste 2 ori (de la 738 978 în anul 2000, la 1 769 230 în anul 2009). Punctul critic al creşterii a fost observat în perioada 2005-2006, când întreaga finanţare a serviciilor spitaliceşti a fost preluată de către NHIF.Analiza este bazată pe rapoartele anuale financiare ale Casei Naţionale de Asigurări de Sănătate (NHIF) din Bulgaria, pe statisticile anuale de sănătate publică publicate de către Centrul Naţional de Informatică în Sănătate, şi pe date corespondente pentru ţările europene colectate din baza de date Health for All, la nivelul anilor 2000-2009.acestui articol este de a explora tendinţa evolutivă a spitalizărilor şi de a analiza principalii factori determinanţi ai supra-spitalizării.Schimbarea management-ului şi finanţării sistemului de sănătate din Bulgaria, după anul 2000, a condus la apariţia a noi probleme în organizarea şi managementul activităţii medicale, în special în ceea ce priveşte îmgrijirile spitaliceşti, probleme ce au apărut după adoptarea Legii Unităţilor Medicale, în anul 1999. Probleme serioase privind serviciile spitaliceşti au apărut în legătură cu cererea indusă pentru serviciile spitaliceşti care contribuie la supra-spitalizare şi cheltuieli suplimentare

OPINIA PACIENTILOR SI A MEDICILOR ASUPRA REFORMEI INGRIJIRILOR DE SANATATE DIN BULGARIA

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 asymmetryCONTEXT. Sistemul bulgar de sanatate trece prin schimbari organizationale fundamentale, care au inceput in anul 1998, odata cu adoptarea a trei legi noi esentiale – Legea Asigurarilor de Sanatate (1998), Legea Unitatilor de Ingrijiri de Sanatate (1999) si Legea organizatiilor profesionale ale medicilor si ale medicilor dentisti (1998). Noua legislatie a cladit temelia transformarii radicale a finantarii si a furnizarii serviciilor de sanatate catre populatie, cu introducerea mecanismelor de piata pentru managementul resurselor.  SCOPUL acestui articol este sa analizeze nivelul de acceptare si sa evalueze critic reforma sanitara din Bulgaria, pe baza opiniei pacientilor si a medicilor. METODE. Studiul s-a desfasurat in 2010 in 9 centre regionale urbane selectate aleator. Au fost selectate esantioane nereprezentative de 1863 pacienti si 718 medici din 18 centre medicale ambulatorii si din 11 spitale.  COLECTAREA DATELOR s-a facut cu ajutorul unui chestionar auto-administrat cu 26 intrebari deschise cuprinzand date de identificare, intrebari despre constientizarea, asteptarile, acceptarea si satisfactia fata de diferitele aspecte ale reformei sanitare. REZULTATE. Au rezultat diferente semnificative la raspunsurile referitoare la informatii si la cunoasterea principalelor aspecte ale reformei din sanatate, si un nivel scazut de cunostinte la pacienti. Ambele grupuri au manifestat asteptari nerealiste si maximaliste pentru cresterea consistenta si rapida a calitatii serviciilor medicale, semnificativ mai ridicate in randul grupului de medici, cu exceptia subiectului salariilor acestora. Asteptarile privind efectele negative care au intervenit realmente in timpul procesului de reforma au fost mult mai scazute. CONCLUZII. S-a constatat un nivel semnificativ de necunoastere a diferitelor aspecte ale reformei in randul respondentilor, mai explicit in grupul pacientilor. Intrucat fenomenul asimetriei informationale reprezinta principalul factor al esecului reformei sanitare, ar trebui facute schimbari serioase pentru cresterea nivelului de acceptare publica si profesionala si a satisfactiei fata de reforma din sanatate.  Cuvinte cheie: Bulgaria, reforma ingrijirilor de sanatate, opinia pacientilor, opinia medicilor, asimetrie informational