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A comparison of health system responses to COVID-19 in Bulgaria, Croatia and Romania in 2020

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  • Džakula, Aleksandar
  • Banadinović, Maja
  • Lovrenčić, Iva Lukačević
  • Vajagić, Maja
  • Dimova, Antoniya
  • Rohova, Maria
  • Minev, Mincho
  • Scintee, Silvia Gabriela
  • Vladescu, Cristian
  • Farcasanu, Dana
  • Robinson, Susannah
  • Spranger, Anne
  • Sagan, Anna
  • Rechel, Bernd

Abstract

This article compares the health system responses to COVID-19 in Bulgaria, Croatia and Romania from February 2020 until the end of 2020. It explores similarities and differences between the three countries, building primarily on the methodology and content compiled in the COVID-19 Health System Response Monitor (HSRM). We find that all three countries entered the COVID-19 crisis with common problems, including workforce shortages and underdeveloped and underutilized preventive and primary care. The countries reacted swiftly to the first wave of the COVID-19 pandemic, declaring a state of emergency in March 2020 and setting up new governance mechanisms. The initial response benefited from a centralized approach and high levels of public trust but proved to be only a short-term solution. Over time, governance became dominated by political and economic considerations, communication to the public became contradictory, and levels of public trust declined dramatically. The three countries created additional bed capacity for the treatment of COVID-19 patients in the first wave, but a greater challenge was to ensure a sufficient supply of qualified health workers. New digital and remote tools for the provision of non-COVID-19 health services were introduced or used more widely, with an increase in telephone or online consultations and a simplification of administrative procedures. However, the provision and uptake of non-COVID-19 health services was still affected negatively by the pandemic. Overall, the COVID-19 pandemic has exposed pre-existing health system and governance challenges in the three countries, leading to a large number of preventable deaths.

Suggested Citation

  • Džakula, Aleksandar & Banadinović, Maja & Lovrenčić, Iva Lukačević & Vajagić, Maja & Dimova, Antoniya & Rohova, Maria & Minev, Mincho & Scintee, Silvia Gabriela & Vladescu, Cristian & Farcasanu, Dana , 2022. "A comparison of health system responses to COVID-19 in Bulgaria, Croatia and Romania in 2020," Health Policy, Elsevier, vol. 126(5), pages 456-464.
  • Handle: RePEc:eee:hepoli:v:126:y:2022:i:5:p:456-464
    DOI: 10.1016/j.healthpol.2022.02.003
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    References listed on IDEAS

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    1. Dobrinsky, Rumen, 2000. "The Transition Crisis in Bulgaria," Cambridge Journal of Economics, Cambridge Political Economy Society, vol. 24(5), pages 581-602, September.
    2. Armano Srbljinoviæ & Jasmina Božiæ & Brian D. Fath, 2020. "Croatian crisis management system's response to COVID-19 pandemic through the lens of a systemic resilience model," Interdisciplinary Description of Complex Systems - scientific journal, Croatian Interdisciplinary Society Provider Homepage: http://indecs.eu, vol. 18(4), pages 408-424.
    3. Cylus, Jonathan & Papanicolas, Irene, 2015. "An analysis of perceived access to health care in Europe: How universal is universal coverage?," Health Policy, Elsevier, vol. 119(9), pages 1133-1144.
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    Cited by:

    1. Gabriel Brătucu & Andra Ioana Maria Tudor & Adriana Veronica Litră & Eliza Nichifor & Ioana Bianca Chițu & Tamara-Oana Brătucu, 2022. "Designing the Well-Being of Romanians by Achieving Mental Health with Digital Methods and Public Health Promotion," IJERPH, MDPI, vol. 19(13), pages 1-24, June.
    2. Byrne, John-Paul & Humphries, Niamh & McMurray, Robert & Scotter, Cris, 2023. "COVID-19 and healthcare worker mental well-being: Comparative case studies on interventions in six countries," Health Policy, Elsevier, vol. 135(C).

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