1 research outputs found
Regulatory barriers to equity in a health system in transition : a qualitative study in Bulgaria
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