31 research outputs found

    Regulatory barriers to equity in a health system in transition : a qualitative study in Bulgaria

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    Background: 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. Methods: 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. Results: 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. Conclusions: Regulatory barriers to equity and compliance in daily practice deserve more attention from policymakers 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

    The Effect of Low Corporate Tax Rate on Payroll Tax Evasion

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    It is a commonly held view that the widespread policy of cutting the corporate income tax has a positive effect on taxable income through decreasing firms' incentive to hide profits. A neglected side of this policy, however, is its potential to trigger more evasion in other tax bases, such as the social security base, especially if the corporate income tax rate is low compared to the payroll rate. We develop a model in which employers and employees cooperate in declaring lower wages to the tax authorities in order to evade payroll contributions

    The effects of the 2007 global economic crisis on firm relocation factors: SME movements from Greece to Bulgaria

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    This chapter examines the ways in which the 2007 global economic crisis has influenced firm relocation factors. Firm mobility constitutes a dynamic process, with its aspects changing in response to significant broader processes, such as globalisation. Specifically, the recent crisis has modified the socio-economic conditions under which firms operate. In order to examine the crisis-driven changes in firm mobility, this chapter employs a comparative analysis of the pre- and post-crisis relocation of Greek small and medium-sized companies to Bulgaria, which has recently increased. Greece is at the epicentre of academic and political debate in Europe, being the European Union member state mostly affected by the crisis. In the context of the changing economic and institutional conditions, it is demonstrated that the significance of the firm relocation factors, such as labour cost and level of demand, records considerable differences between the pre- and the post-crisis period
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