health inequities in bulgaria – action and challenges
DESCRIPTION
Health Inequities in Bulgaria – Action and Challenges. Svetlana Spassova, MD Ministry of Health, Bulgaria Chisinau 07.11.2008. WHO's health system performance framework. The Health System in Bulgaria. Addressing inequalities in Bulgaria. Addressing the particular health needs of: - PowerPoint PPT PresentationTRANSCRIPT
Svetlana Spassova, MDMinistry of Health, Bulgaria
Chisinau 07.11.2008
WHO's health system performance framework
The Health System in BulgariaRevenue collection
HNIF: obligatory population-wide health insurance (6%);MoH: budget transfers (4,5% of GDP)Private health insurance companies: voluntary (personal) health insurance (<10% of HC services market);OPP
Pooling NHIF; MoH; private health insurance companies
Purchasing NHIF – for health insured persons, based on solidarity;MoH – for uninsured (emergency, birth assistance, hospital psychiatric service, blood and blood products, transplantations, certain therapies and pharmaceuticals )Private health insurers: additional services (extended package)
Provision Medical establishments: both private and on contract with purchasers
Addressing inequalities in Bulgaria
Addressing the particular health needs of:- Uninsured people;- People with low income;- Disabled people;- Vulnerable groups: children, youth, elderly;- Minorities;- People, suffering from specific diseases.
Addressing inequalities: StewardshipLegislative provisions: The Law on Health and
secondary by-law guarantee access to certain healthcare services, regardless of insurance status;
The National Health Strategy: putting the issue of addressing inequalities on the political agenda;
National strategies and programs targeting disadvantaged groups: focus on information, disease prevention, provision of services and treatment;
The EU-Pre-accession instruments (the PHARE-program) and the Structural funds
Addressing inequalities: Investment and training
Availability of qualified human resources- specialization system financed by the state;
Investments in infrastructure and facilities – state financed investment policy provided by MoH, projects financed under the pre-accession and Structural funds; municipal budgets
Access to pharmaceuticals – legislation on pharmaceuticals and medical devices; control of prices of prescription drugs linked to external and internal reference and inflation; positive drug list
Addressing inequalities: Service deliveryState budget financed access to emergency healthcare,
midwifery care, organ transplantations and follow up treatment, central procurement of pharmaceuticals for cancer diseases, rare disease, blood disorders, transplants and dialysis; immunization and vaccines, neonatal screening of genetic diseases; access to national, regional and community programs, transportation, mobile structures and outreach programs.
National programs, targeting:- disadvantaged groups: minorities, people with mental
disorders, people with rare diseases, etc.- diseases, representing significant socio-economic
burden: cancer, tuberculosis, HIV/ AIDS, etc.
Addressing inequalities: FinancingNational budget spending on: - health services for uninsured;- health services for specific vulnerable groups;- national, regional and communal programs.- infrastructure External funding:- EU fund spending on specific projects, targeting
minorities or diseases, affecting predominantly vulnerable groups.
- The Global Fund to fight AIDS, tuberculosis and malaria
- infrastructure, regional development, strengthening of human resources and administrative capacity;
Strengthening health system - performance and challenges
Improving health in equitable way requires:
Functions of the health system, related to reforms
Reform plans, oriented towards goalsOverall goals, split into specific objectivesMeasurable intermediate objectives, leading
to achievement of national objectives
Addressing inequalities: Challenges• Defining and implementing reforms and
investments, aimed at those most in need of care; Balancing competing demands and setting clear
policy priorities Creating awareness in order to prevent conflicts
between different members of societyDeveloping programs, that deliver added value and
have defined measurable outcomesEnsuring the availability of qualified health force;
creating incentives for medical professionalsDeveloping PPP
Addressing inequalities: Challenges
Financial restrictions require prioritizingReducing financial barriers which hinder
access to needed careEnsuring continuity: a stable flow of resourcesReaching the disadvantaged people; monitoring
the responsiveness of servicesEvaluating the impact of service delivery
strategies.
Measuring Outcomes: Conclusions
Measures aimed at addressing inequalities strengthen health system performance, if resulting in
Better health throughout the entire population;Responsiveness of the system to specific needs
and vulnerabilities;Sufficient funding and optimal redistribution
so as to enable universal access to health services.
Bulgaria
Thank you for your attention!
Svetlana Spassova, MDNational Health Policy Director,
Ministry of Health - Bulgaria