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Patient charges for health services: the opinions of healthcare stakeholders in Bulgaria

Authors

  • Elka Atanasova,

    Corresponding author
    1. Department of Economics and Healthcare Management; Faculty of Public Health, Medical University, Varna, Bulgaria
    2. Department of Health Services Research; CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
    • Correspondence to: E. Atanasova, Department of Economics and Healthcare Management; Faculty of Public Health; Medical University, Marin Drinov Str. 55, Varna 9002, Bulgaria. E-mail: elka1105@yahoo.com

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  • Milena Pavlova,

    1. Department of Health Services Research; CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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  • Emanuela Moutafovа,

    1. Department of Economics and Healthcare Management; Faculty of Public Health, Medical University, Varna, Bulgaria
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  • Todorka Kostadinova,

    1. Department of Economics and Healthcare Management; Faculty of Public Health, Medical University, Varna, Bulgaria
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  • Wim Groot

    1. Department of Health Services Research; CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
    2. Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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Abstract

The reforms of the Bulgarian healthcare sector have been widely discussed, both nationally and internationally. In spite of the reforms, problems with the efficiency, equity and quality in healthcare provision continue to exist in Bulgaria. Among others, the reforms included the implementation of formal patient charges for the use of healthcare services. These were established in the country in 2000. Formal patient charges are applied to all levels of medical services with the exception of emergency care. The aim of this paper is to describe and analyze the attitudes of Bulgarian healthcare stakeholders toward patient charges. The analysis is based on data collected in focus group discussions and in-depth interviews carried out in Bulgaria in May–June 2009. The paper concludes by recommendations for policies related to patient payments. The social sensitivity of these payments requires broad discussion before policy decisions are implemented. There is also a need of a well-thought communication strategy on the issue of patient payments by the Ministry of Health. Copyright © 2013 John Wiley & Sons, Ltd.

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