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

sspassova@mh.government.bg