Costing of healthcare services in Bulgaria – guidelines for implementing some good practices

Costing of healthcare services is one of the most severe challenges facing hospitals’ accounting and management teams.The article presents the characteristics, advantages, and limitations of three different approaches to costing medical services – Time-Driven Activity-Based Costing, Target Costing, and Micro-Costing. We provide a summary of theinternational experience in their application, and guidelines for their implementation in the Bulgarian context.Aligning the costing systems with current developments in the management accounting field has the potential to improve hospitals’ cost management and their financial condition.At a health system level, accumulating reliable information on the actual cost of medical services would facilitate theprocess of setting fair reimbursement prices and thus result in more effective ways to spend the scarce resources

History and development of personalized medicine

The development of personalized medicine is associated not so much with the idea of personalization presentedby Hippocrates more than 2400 years ago but with the development and increase of the precision in diagnosisand treatment (Gordon & Koslow, 2011; Sykiotis, Kalliolias, Papavassiliou, 2005).Even then, the „father of medicine“ – Hippocrates discussed how much more important is to be known what kind of aperson has a disease than to know what sort of disease a person has. In addition, Hippocrates also noted that differentmedicines should be given to different patients (Pray, 2008).Today, the term „personalized medicine“ is defined as „providing the right patient with the right drug at the right timewith the right dose“ (FDA).According to the National Institutes of Health (NIH), precision medicine is a „new approach to the prevention and treatmentof the disease and it is based on the individual variability of the genes, the environment and the lifestyle of eachperson.“ This approach enables doctors and scientists – to accurately predict which therapeutic and preventative strategies for a particular disease would have an effect in which groups of people.This is an opposition to the universal approach in which therapeutic and preventive strategies are developed for the„average-statistical“ person, without taking into account the differences between each individual.Personalized medicine is also defined as a „medical model based on the identification of the individual’s phenotype andgenotype (e.g. molecular profiling, medical imaging, lifestyle data, etc.). In order to be created an appropriate therapeuticstrategy for the right person at the right time and/or to identify the predisposition to an illness for timely and focusedprevention „(The European Alliance for Personalized Medicine (EAPM).The aim of the article is to be made a historical review of personalized medicine by examining and defining the mainstages of development – from its emergence to the present.The study is based on a literature review of scientific sources (printed and electronic) related to the article topic.As a result of the study, the following 5 stages of personalized medicine development are defined:• Preparatory stage (1931-1984) – from the idea of individual of treatment to mapping of the human genome. In thisstage, the topic of individualized treatment has begun to be discussed. In addition, the foundations of the creation ofpersonalized medicine are placed in order to be a revolution in medicine today.• The first stage (1984 – 2002) – human genome mapping, approval of first target therapy and first companion diagnosisco-developed with the drug. The term „personalized medicine“ emerged.• Second Stage (2003-2012) – Establishment of companion diagnosis by which medical professionals determine whichtarget therapy is appropriate for patients and at what dosage.• Stage Three (2012-2016) – the final results of the Human Genome project are presented. The essence and the importanceof personalized medicine and companion diagnosis are appreciated. The European Alliance for PersonalizedMedicine (EAPM, 2012), The Bulgarian Association for Personalized Medicine – (BAPEMED,2014) and BulgarianAlliance for Precision and Personalized Medicine (BAPPM, 2016).• Fourth stage (from 2017) – The target therapies and drugs become common and necessary practice. There is tremendousgrowth in the development of personalized medicine. By 2018, the Food and Drug Administration (FDA)approved 115 target cancer therapies (National Cancer Institute, 2018), and 41 target therapies and drugs wereregistered by the (Bulgarian Drug Agency, BDA) in Bulgaria until 2018.In conclusion, today’s personalized medicine is changing the medicine and patient care by providing personalized treatmentbased on the individual genetic characteristics of each patient and his illness

Clinical pathways - a retrospective view on their application as a financial tool in Bulgarian hospitals.

Abstract IntroductionDuring 2000-2001, CPs were developed and implemented as a temporary solution for financing the hospitals in Bulgaria. The aim of this article is to study and trace the application of clinical pathways as a tool for hospital funding in Bulgaria. Material and methodsIn order to examine the implementation and the progress of CPs in Bulgarian hospitals we have studied Bulgarian and foreign publications. In addition to this, we also include official reports published by the Ministry of Health, Ministry of Finance, National Health Insurance Fund (NHIF), The National Center of Public Health and Analyses (NCPHA) and others.Results and discussionFor the first time, CPs are negotiated and included in the National Framework Contract in 2001. Gradually, the number of CPs increased and reached more than 300 in 2015. The introduction of CPs as a tool for financing the hospital care is related to the need of fixing the prices of the respective CPs. Initially, the NHIF and the Bulgarian Medical Association developed a common methodology for fixing the prices of CPs. Since 2011, an amendment to the Health Insurance Act stipulates that the procedures for valuation and payment of activities by NHIF are defined by explicit methodologies. We have found that not all hospitals submit information to the specialized software for hospitals which is the only tool for analyzing the costs structure in the health care establishments at present.ConclusionThe clinical pathways are not accepted as a sufficient effective mechanism for hospital funding in Bulgaria. Moreover, the lack of accurate and comparable information makes the analyses incomplete and vulnerable

Financial analysis of university hospitals in Bulgaria

Improving the financial condition of university hospitals is a high priority for their owners and stakeholders. One of the most common problems for state-owned hospitals in Bulgaria is their financial instability. The stable financial state of these hospitals is imperative for their increasing development and ensures the success of their socially required functions.The study aims to analyse the financial health of university hospitals in Bulgaria and draw conclusions regarding the hospitals' long-term solvency and level of financial stability.The study covers a period of five years, from 2017 to 2021. Key financial indicators are observed to assess the financial state of the predominantly government-owned university hospitals. The primary information source for this study is the annual financial statements published in the Commercial Register.Results indicate a contrast in the values of financial indicators between hospitals in good and improving financial states and those in deep financial distress. In the latter, there is a high level of dependence on creditors and financial support by the owner. There is a clear correlation between low liquidity and profitability ratios and changes in capital structure, leading to increased indebtedness and deepening processes of reducing owner's equity.The results of the financial analyses are crucial to the hospital management boards. They provide detailed information on the current financial health and have high predictive value. Every responsible health manager should be familiar with the indicators for assessing the financial status of the structure they manage and take measures when alarming trends are present. The financial analysis should be used as a basis for better-informed management decisions

ANALYSIS OF PROPERTY STRUCTURE OF MEDICAL DIAGNOSTIC CONSULTATIVE CENTERS IN VARNA

The production and financial performance of one company depend on the size of its assets and the aptness of the assets� proportion. The aim of this article is urged to make an external analysis of the asset structure of medical diagnostic and consultative centers (DCC) in Varna and on this basis to draw conclusions regarding their property structure. Subject of the study is the annual financial statements, published in the Commercial Register, of all 9 in number DCCs that are registered in Varna. The names of DCC's are encoded with numbers from 1 to 9, with numbers from 1 to 7 are 6 DCCs, owned by the Municipality of Varna, one of them is a subsidiary of staterun hospital, with number 8 and 9 are private DCC's. Subject of the study are the assets and their proportion in the studied hospitals. The study covers 7 years - from year 2008 to year 2014. In the study are calculated and compared the indicators for intensity of the property as well as the relative share of the fixed assets obtained as an average value of the relative shares of all nine in number hospitals for the entire studied period. The following important conclusions have been made: 1) The average relative share of fixed assets of Varna DCCs for the period 2008 � 2014 is 56.85%. 2) The proportion of FA calculated only for municipal DCC's (average value) is significantly higher - 72.75% compared to the overall average of 56.85%. 3) Private hospitals invest a lot less money in fixed assets than the municipal ones. 4) Since 2013 there is a slight increase of FA share in the private and the state-run DCC, and a slight decrease in the municipal ones (71.93). 5) The creation of an online database comprising of average indicators of the financial and property status of Bulgarian companies is essential and necessary condition for improving their competitiveness by providing reliable, accurate and usable information for comparison

ANALYSIS OF FINANCIAL AUTONOMY AND INDEBTEDNESS OF MEDICAL DIAGNOSTIC CONSULTATIVE CENTERS IN VARNA

In the study are calculated and compared indicators of autonomy and indebtedness, and the relative shares of equity, liabilities and funding in the total capital of the studied hospitals for the analyzed periods. The following important conclusions have been made: 1) half of the analyzed municipal DCCs, 3 out of total 6 (DCC 3, 4 and 5) can be classified as financially independent (the share of attracted capital is around or below 30%), with low level of indebtedness (on average less than 0.6), which indicates a good financial stability of these hospitals. Financially stable is one private DCC, encoded under number 8; 2) two municipal DCC's, analyzed under number 1 and 2, and DCC 7 (a subsidiary of state-run hospital) have a relative share of the borrowed capital around and slightly over 60%, and high level of indebtedness - over 1.4 (calculated by method 1) and over 3 (calculated by method 2), suggesting that these hospitals are not financially stable and are dependent on creditors; 3) The analyzed indicators of the municipal DCC, encoded under number 6, and private DCC, encoded under number 9 show that these hospitals are highly financially dependent on creditors with impaired solvency and there is a real risk of insolvency; 4) The amount of the allowances that are associated with the obligations may affect the value of financial ratios of the DCCs, as is the case of DCC 7; 5) when analyzing the capital structure and long-term solvency should be taken into consideration the impact of funding to reduce the financial risk 6) The creation of an online database comprising of average indicators of the financial and property status of Bulgarian companies is essential and necessary condition for improving their competitiveness by providing reliable, accurate and usable information for comparison

Personalized medicine from ancient times to the present

Introduction: The history of personalized medicine could be traced back to ancient times. The term personalized medicine is defined by The Food and Drug Administration (DFA) as `providing the right patient with the right drug at the right dose at the right time`. The aim of study is to identify different stages of the personalized medicine development.Materials and Methods: The research is based on a literature review. Scientific printed and electronic sources have been used. Systematisation and classification as basic scientific methods have been applied.Results: Four stages of personalized medicine development have been identified. The personalized methods of healing have been discussed by Hippocrates. Thus, the first stage could be attributed with the emerging of the early concept. The Human Genome Project (1984-2002), which was closely related with the personalized medicine development, was identified as the second stage and its presentation in 2003 marked the begging of the third stage. As a result of the project, in present, the personalized medicine combines pharmacogenomics or pharmacokinetics information with the traditional methods in order to identify patient`s individual characteristics. Companion diagnostics help medical specialist to decide which target therapy and in what dosage to use in a patient treatment. The fourth stage of the personalized medicine development embraces the period after 2012. The first target therapy, called Kalydeco, was approved by the FDA in 2012. The FDA have approved more than 90 target therapies until 2017. Thirty-five of them are available in Bulgaria. The European Alliance for Personalized Medicine was launched in 2012. Two associations for personalized medicine were introduced in Bulgaria in 2014.Conclusion: Personalized healing can be traced back to ancient times. Today personalized medicine is changing the medical world and patient care, providing opportunity for personalized treatment. The personalized medicine development in the recent years is strongly related with advances in pharmacogenetics and pharmacokinetics

Behaviour and attitudes of students at the Medical University - Varna to voting

Introduction: Voting is a fundamental mechanism for citizens` control over public policies develop­ment, including those in healthcare. Therefore, the citizens` behaviour and attitudes to voting are of crucial importance for public development and democracy. Special research interest in this regard falls on the young perspective people. The aim of this research is to shed a light on the behaviour and attitudes of the students in MU Varna to voting. More specifically we examine whether the students vote based on candidates` platforms and how are they satisfied with the subsequently implemented policies.Materials and Methods: A sociological survey is conducted among Bulgarian and German students of the Medical University - Varna. The questionnaire consists of 11 open and closed questions. A total of 350 students took a part in the survey (200 Bulgarian students and 150 German students). The survey was conducted in December 2017 to January 2018.Results: More than 60% of the Bulgarian students and nearly 70% of the German students have vot­ed in parliamentarian elections in their home country. More than 70% of all respondents voted after a research on the candidates` election platforms. Over 40% of the Bulgarian students are dissatisfied with the conducted policies after the elections. In contrast, approximately 55% of the German stu­dents declare they have been satisfied with policies implemented after the elections.Conclusion: Students in general have an active civil stance. Most of them vote, informed from the can­didates` platforms. However, satisfaction with the policies implemented after the elections vary sig­nificantly between Bulgarian and German students with Bulgarian students being much more dis­satisfied

50 години Катедра „Социална медицина и организация на здравеопазването`

22 Май 201