Informal payments - definitions and concepts

Informal payments became an interesting issue in the context of healthcare reforms and a very widespreadphenomenon in the healthcare sector that has been observed in many transition countries of Central and Eastern Europe, Asia and Africa. Some studies have been conducted to clearly identify informal payments to overcome this complex problem with many „faces`. The latter includes a variety of names to denote the phenomenon: gratuities, gratitude payments, under-the-counter payments, unofficial payments and etc. The concepts mentioned in the current article such as illegality, informality, and corruption have a negative impact inthe understanding of the informal payment. The main strategies of the world literature to deal with this phenomenon are summarized

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

Out-of-pocket payments for health care services in Bulgaria: financial burden and barrier to access.

BACKGROUND: In recent years, Bulgaria has increasingly relied on out-of-pocket payments as one of the main sources of health care financing. However, it is largely unknown whether the official patient charges, combined with informal payments, are affordable for the population. Our study aimed to explore the scale of out-of-pocket payments for health care services and their affordability. METHODS: Data were collected in two nationally representative surveys, conducted in Bulgaria in 2010 and 2011, using face-to-face interviews based on a standardized questionnaire. To select respondents, a multi-stage random probability method was used. The questionnaire included questions on the out-of-pocket payments for health care services used by the respondent during the preceding 12 months. RESULTS: In total, 75.7% (2010) and 84.0% (2011) of outpatient service users reported to have paid out-of-pocket, with 12.6% (2010) and 9.7% (2011) of users reporting informal payments. Of those who had used inpatient services, 66.5% (2010) and 63.1% (2011) reported to have made out-of-pocket payments, with 31.8% (2010) and 18.3% (2011) reporting to have paid informally. We found large inability to pay indicated by the need to borrow money and/or forego services. Regression analysis showed that the inability to pay is especially pronounced among those with poor health status and chronic diseases and those on low household incomes. CONCLUSION: The high level of both formal and informal out-of-pocket payments for health care services in Bulgaria poses a considerable burden for households and undermines access to health services for poorer parts of the population

Coverage of dental services by the National Health Insurance Fund in Bulgaria

The global population often overlooks the importance of maintaining dental health, despite the fact that early detection can prevent the majority of dental diseases. It is quite common for patients to be unable to access dental treatment due to the lack of coverage in their health insurance packages. In this study, we examined the coverage of dental activities provided to health-insured patients in Bulgaria by the National Health Insurance Fund, using the framework of the Universal Health Coverage Cube, which includes width (coverage extent), depth (proportion of costs covered), and scope (covered services). The analysis incorporates dentists' perspectives on the publicly covered package of dental care within the country. Unfortunately, there are significant gaps in the healthcare system's coverage for one of the most prevalent dental diseases, and preventive activities are also not included. These limitations in the scope of public coverage hinder patients from accessing the necessary dental services in a timely and comprehensive manner

ANALYSIS OF INCOME AS A „GENERATION OF INCOME“ ACCOUNT COMPONENT

Сметка „Формиране на дохода“ съдържа информация за елементите на добавената стойност: компенсация на наетите лица, данъци върху производството и вноса, субсидии, брутен опериращ излишък, брутен смесен доход. Тя допълва информацията на сметка „Производство”, като дава възможност да се анализира равнището на заплащането на труда по сектори и икономически дейности на икономиката. Данните от тази сметка позволяват да се обвържат доходите от производствената дейност с постигнатите резултати по сектори и икономически дейности. В статията е извършен статистически анализ на информацията, съдържаща се в сметка „Формиране на дохода“ за периода 2000-2012 г., за да се установят формиралите се макроикономически тенденции. „Generation of income" account contains information on value added components: compensation of employees, taxes on production and imports, subsidies, gross operating surplus, gross mixed income. It complements the information of "Production" account, allowing analysis of the level of wages in sectors and industries of the economy. Data from this account allow committing the income from productive activity to the results achieved by sectors and economic activities. This article provides an analysis of the statistical information contained in the "Generation of income" account for the period 2000-2012, to identify the formation macroeconomic trends

Microbial diversity in heavy-metal polluted waters

Indigenious water microflora as well as the presence of metal- and xenobiotic biotransforming bacteria were investigated in waters near the KCM Pb-Zn smelter, South Bulgaria. Content of As, Hg, Cd, Mn, Pb, Cu and Zn exceeded in times the maximum permission standart. Absence of some microbial groups demonstrated a change in the microbial community structure in the region. Ecotoxicology test ISO/DIS 10712.2 displayed toxic environmental effect of the polluted waters, especially one of them which demonstrated 72 % of ecotoxicity. More than 20 ecologically relevant new bacteria were cultured. Three of them demonstrated tolerance to Cd, Cu and Mn and five- a tolerance to 2,4-dichlorphenoxyacetic acid. Our result revealed that the heavy metal pollutions reduced the microbial diversity in the studied waters, are ecotoxic as well as that some of newly isolated bacteria possess a capacity for a clean-up biotechnologies in the region. . 1, . 2, 2., 3, 3, .

Consumer Preferences for Pharmacy in Highly Competitive Environment

Introduction. In recent years, the pharmacy market in Bulgaria is dynamically developing with increasingconcentration of retailers in the big cities. The aim of this study is to analyse the factors influencing consumer choice of a pharmacy in a highly competitive environment.Materials and Method. The study was conducted among 433 consumers in the city of Varna between February and April 2017. Direct anonymous inquiries were used to investigate consumer opinion, including factors affecting the choice of a pharmacy and over-the-counter medicines.Results and Discussion. The results show that the majority of the respondents attend relatively regular pharmacies - at least once a month or more frequently. For purchase of food supplements, over 50% of consumers prefer pharmacy versus drugstores and non-pharmacy retailers. Geographic proximity and price level are reported as most important factors in pharmacy choice. Counselling by qualified staff is important to 65% of respondents and could be interpreted as a factor stimulating re-selection of the retailer. Product range and competitive prices also have an impact on loyalty. For the purchase of over-the-counter drugs and food supplements, respondents rely heavily on the recommendation of a doctor (48%) or a pharmacist (37%), who in this case form and predetermine consumers` choice.Conclusions. The intensity of competition is often associated with a price reduction or higher differentiation between market players. Analysing the factors and motives of consumer choice in a highly competitive environment is crucial for successful positioning and market performance of pharmacies

Socio-economic health inequalities in use of health care services in Bulgaria

Въведение: Различни изследвания показват, че по-бедните хора от населението имат по-големи здравни потребности, докато използването на здравни услуги е концентрирано сред по-богатите прослойки на обществото. Целта на настоящата статия е да се изследват социоикономическите здравни неравенства в използваемостта на различни видове здравни услуги в България.Материал и методи: В изследването са използвани данни от проведено социологическо проучване чрез анкета. Проучването е проведено в периода март-юни 2014 г. сред 618 граждани на Североизточния район на планиране.Резултати: От стойностите на коефициента на поляризация се вижда, че по-висока е използваемостта на здравни услуги от хората с по-ниски доходи. Изключение правят само денталните услуги. Емпиричните стойности на t-критерия на Стюдент по видове лечебни заведения показват, че статистически значими различия между групите с най-ниски и най-високи доходи съществуват при ползването на общопрактикуващ лекар, лекар-специалист и при приема в болница.Дискусия: Резултатите от нашето изследване показват, че статистически значими различия се наблюдават в използването на здравни услуги от респондентите с различни равнища на доход. Финансовата тежест на разходите за здравеопазване създава сериозни бариери в достъпа до здравни услуги, особено за по-бедните домакинства, неосигурените лица и другите уязвими групи.Заключение: Въпреки задълбочаването на проблема с неравенствата в използването на здравни услуги, мерките от страна на здравните власти са все още твърде ограничени.Introduction: Different studies show that those at the lower end of the income distribution have the greatest needs for health care but usually those in higher income groups use more health care services especially specialised ones. The aim of this article is to investigate socio-economic health inequalities in the utilisation of health care services in Bulgaria. Material and Methods: Data from inquiry are used to analyse the socio-economic health inequality. The inquiry is conducted in 2014 among 618 citizens of Nord-East region in Bulgaria.Results: Values of odds ratio show that people at the lower end of the income distribution use more health care services except in the dental care. Differences in utilization of outpatient and inpatient services are measured at different income groups through Student t-test.Discussion: Our analyses suggest that income inequalities are related with health inequalities in the utilisation of health care services in Bulgaria. Financial burden of private health expenditure creates barriers in access to health care services especially for poorer part of the population, uninsured people and other vulnerable groups. Conclusion: Although the health sector faces serious challenges with income-related health inequalities, the policy measures are still inadequate

Long-term care in the health system: European tendencies and Bulgarian experience

Introduction: One of the most serious challenges faced by health systems in the world is the population ageing, which stresses the increasing importance of long-term care. This article aims at providing a concise definition of long-term care, the kinds of services included in it, the trends in the long-term care costs and the scope of the services, as well as the various financial arrangements for long-term care.Materials and methods: This is a review article, which summarizes the findings in the literature concerning the content and scope of the concept „long-term care`. An attempt has been made to give a short classification of the types of long-term care services and their financing. The paper is based on materials, analyses and statistical data by the Organization of Economic Cooperation and Development (OECD), the European Union and Bulgarian sources.Results and Discussion: The term „long-term care` refers to a range of services provided for people with limited ability (physical and/or mental) to function who therefore depend on an outside assistance for meeting various needs (medical and nonmedical) for an extended period providers. The share of long-term care health costs in GDP and in total health costs varies significantly across the EU member-states. It is substantially lower in the new Central and Eastern European members, among which Bulgaria ranks last. EU countries can be grouped on different dimensions to deliver a typology of long-term care systems, some of the classifications being presented in the article.Conclusion: The long-term care system faces a number of challenges, connected with the increasing costs parallel with the rising expectations for a higher quality and efficiency. A challenge in every country, even the most developed one, is the provision of the adequate number and qualification mix of formal carers as well as various types of assistance for the informal carers - financial, information, consultative and psychological