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What have 10 years of health insurance reforms brought about in Bulgaria? Re-appraising the Health Insurance Act of 1998

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  • Atanasova, Elka
  • Pavlova, Milena
  • Velickovski, Robert
  • Nikov, Bogomil
  • Moutafova, Emanuela
  • Groot, Wim

Abstract

This article discusses the financial reforms in the Bulgarian public health care sector. Since 1998, when the Bulgarian parliament passed the Health Insurance Act, compulsory contributions for social health insurance have become the main source of health care financing. They replaced the previous tax-based health care funding mechanism. This article reviews empirical evidence and macro indicators to analyse to what extent the expectations of this reform are achieved. Two groups of sources are reviewed: (1) publications prior to the implementation of the social health insurance in Bulgaria that discuss its potential impact; (2) publications after the insurance implementation, that investigate the actual impact of this reform. The results suggest that social health insurance in Bulgaria brought about certain efficiency improvements in the public health care sector. However, the overall social benefit of the reform is doubtful. The main reasons for this are related to the ineffective organisation of the Bulgarian public health care sector, as well as to the overall lack of financial resources for health care in the country.

Suggested Citation

  • Atanasova, Elka & Pavlova, Milena & Velickovski, Robert & Nikov, Bogomil & Moutafova, Emanuela & Groot, Wim, 2011. "What have 10 years of health insurance reforms brought about in Bulgaria? Re-appraising the Health Insurance Act of 1998," Health Policy, Elsevier, vol. 102(2), pages 263-269.
    • Handle: RePEc:eee:hepoli:v:102:y:2011:i:2:p:263-269
    DOI: 10.1016/j.healthpol.2010.12.001
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    References listed on IDEAS

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    1. Balabanova, Dina & McKee, Martin, 2002. "Understanding informal payments for health care: the example of Bulgaria," Health Policy, Elsevier, vol. 62(3), pages 243-273, December.
    2. Pavlova, Milena & Groot, Wim & van Merode, Frits, 2000. "Appraising the financial reform in Bulgarian public health care sector: the health insurance act of 1998," Health Policy, Elsevier, vol. 53(3), pages 185-199, October.
    3. Pashev, Konstantin, 2006. "Healthcare Reforms in Bulgaria: Towards Diagnosis and Prescription," MPRA Paper 999, University Library of Munich, Germany.
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    6. Ms. Nora K Markova, 2006. "How Does the Introduction of Health Insurance Change the Equity of Health Care Provision in Bulgaria?," IMF Working Papers 2006/285, International Monetary Fund.
    7. Milena Pavlova & Wim Groot & Godefridus Van Merode, 2004. "Willingness and ability of Bulgarian consumers to pay for improved public health care services," Applied Economics, Taylor & Francis Journals, vol. 36(10), pages 1117-1130.
    8. Borissov, Vesselin & Rathwell, Tom, 1996. "Health care reforms in Bulgaria: An initial appraisal," Social Science & Medicine, Elsevier, vol. 42(11), pages 1501-1510, June.
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    Cited by:

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    3. Thijs Schoot & Milena Pavlova & Elka Atanasova & Wim Groot, 2017. "Preferences of Bulgarian consumers for quality, access and price attributes of healthcare services—result of a discrete choice experiment," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(1), pages 47-71, January.
    4. Danyliv, Andriy & Groot, Wim & Gryga, Irena & Pavlova, Milena, 2014. "Willingness and ability to pay for physician services in six Central and Eastern European countries," Health Policy, Elsevier, vol. 117(1), pages 72-82.
    5. Petra Baji & Milena Pavlova & László Gulácsi & Miklós Farkas & Wim Groot, 2014. "The link between past informal payments and willingness of the Hungarian population to pay formal fees for health care services: results from a contingent valuation study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 853-867, November.
    6. Vakulenko Veronika & Mattei Giorgia, 2023. "Reforming the Public Sector in Eastern European and Former Soviet Union Countries: A Systematic Literature Review," Central European Journal of Public Policy, Sciendo, vol. 17(1), pages 55-79, June.
    7. Tambor, Marzena & Pavlova, Milena & Rechel, Bernd & Golinowska, Stanisława & Sowada, Christoph & Groot, Wim, 2014. "Willingness to pay for publicly financed health care services in Central and Eastern Europe: Evidence from six countries based on a contingent valuation method," Social Science & Medicine, Elsevier, vol. 116(C), pages 193-201.
    8. Elka Atanasova & Milena Pavlova & Emanuela Moutafovа & Todorka Kostadinova & Wim Groot, 2015. "Patient charges for health services: the opinions of healthcare stakeholders in Bulgaria," International Journal of Health Planning and Management, Wiley Blackwell, vol. 30(3), pages 232-245, July.
    9. Tambor, Marzena & Pavlova, Milena & Golinowska, Stanisława & Sowada, Christoph & Groot, Wim, 2013. "The formal–informal patient payment mix in European countries. Governance, economics, culture or all of these?," Health Policy, Elsevier, vol. 113(3), pages 284-295.
    10. Dimova, Antoniya & Rohova, Maria & Hasardzhiev, Stanimir & Spranger, Anne, 2018. "An innovative approach to participatory health policy development in Bulgaria: The conception and first achievements of the Partnership for Health," Health Policy, Elsevier, vol. 122(2), pages 81-86.

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