World Bank2013-10-032013-10-032012https://hdl.handle.net/10986/16082The health system in Bulgaria has undergone significant transformations since the transition and it continues to evolve. This policy note updates a similar document prepared in 2009. It highlights some positive developments, particularly in the area of public health, but continues to find gaps that recent reforms have been unable to reverse. In particular: i) health status in Bulgaria is improving at a slower pace than in other European Union (EU) countries, and the burden of non-communicable diseases is particularly high; ii) coverage of preventive services is low and Bulgarians are much more frequently hospitalized than other Europeans, a sign that the system may not be producing the right mix of services; iii) Bulgarians are among the least satisfied Europeans when it comes to their health system; and iv) total health expenditure is comparable to that of countries with similar income, but the out-of pocket share is disproportionately large and has grown over time, and the financial protection provided by the system is incomplete. Whilst more public expenditure on health will be needed in the medium to long-term, any increases should be accompanied by improvements in efficiency and effectiveness in order to make the best use of resources and ensure the delivery of better health outcomes. This policy note thus primarily focuses on three areas where decisive and prompt action could rapidly bring results and improve the experience of Bulgarian citizens: hospitals, outpatient care, and drug policies. These issues are closely interlinked and tackling them is a key to the modernization of service delivery in all European countries. Indeed, in order to face the challenges brought about by ageing and non-communicable diseases and to meet the population's needs and expectations, new models of health and social care need to emerge that enable patients to stay out of hospital. This is possible through technological change, but can only happen if the outpatient sector delivers more and patients can manage diseases and risk factors through access to appropriate services and medicines.en-USCC BY 3.0 IGOAGEDAGINGAMBULATORY SECTORBASIC NEEDSBASIS FOR ACTIONBEDSBURDEN OF DISEASECAPITAL COSTSCAPITATIONCARDIOVASCULAR DISEASESCARE PERFORMANCECAUSES OF DEATHCERVICAL CANCERCHRONIC DISEASECIRCULATORY SYSTEMCITIZENSCLINICAL GUIDELINESCLINICAL SERVICESCOMMUNICABLE DISEASESCOMPLICATIONSCOST CONTROLDEATH RATEDEATH RATESDEATHSDEBTDECISION MAKINGDEMOGRAPHIC TRANSITIONDEMOGRAPHIC TRENDSDEPENDENCY RATIODIABETESDIETDISABILITIESDISPARITIES IN HEALTHDOCTORSEARLY DETECTIONELDERLYESSENTIAL DRUGSFERTILITYFERTILITY RATESFINANCIAL CONSTRAINTSFINANCIAL INCENTIVESFINANCIAL MANAGEMENTFINANCIAL PRESSUREFINANCIAL PROTECTIONFIXED COSTSFUTURE GROWTHGENERAL PRACTITIONERSGLOBAL BUDGETSGLOBAL HEALTHGROSS DOMESTIC PRODUCTGROSS NATIONAL INCOMEHEALTH CAREHEALTH CARE COSTSHEALTH CARE PROVIDERSHEALTH CARE SECTORHEALTH CENTERSHEALTH EXPENDITUREHEALTH EXPENDITURE PER CAPITAHEALTH FOR ALLHEALTH IMPACTSHEALTH INDICATORSHEALTH INEQUALITIESHEALTH INFORMATICSHEALTH INFORMATIONHEALTH INSURANCE FUNDSHEALTH INTERVENTIONSHEALTH MINISTRIESHEALTH ORGANIZATIONHEALTH OUTCOMESHEALTH PROFESSIONALSHEALTH SECTORHEALTH SECTOR REFORMHEALTH SERVICESHEALTH SPECIALISTHEALTH SPENDINGHEALTH STATUSHEALTH STATUS INDICATORSHEALTH SYSTEMHEALTH SYSTEMSHEALTH SYSTEMS IN TRANSITIONHEALTH WORKFORCEHEALTH-CAREHIGH BLOOD PRESSUREHOME CAREHOSPICEHOSPITALHOSPITAL AUTONOMYHOSPITAL BEDSHOSPITAL BUDGETSHOSPITAL CAPACITYHOSPITAL CAREHOSPITAL COSTHOSPITAL COSTSHOSPITAL FINANCINGHOSPITAL FUNDINGHOSPITAL MANAGEMENTHOSPITAL SECTORHOSPITAL SERVICESHOSPITALSHOUSEHOLD EXPENDITUREHUMAN DEVELOPMENTHUMAN RESOURCESHYPERTENSIONILLNESSIMMUNIZATIONIMPACT ON HEALTHINCOMEINEQUITIESINFANTINFANT DEATHSINFANT MORTALITYINFANT MORTALITY RATEINFANT MORTALITY RATESINFLUENZAINFORMAL PAYMENTSINFORMATION SYSTEMSINTEGRATIONINTERNATIONAL COMPARISONSINTERVENTIONLABOR MARKETLEADING CAUSESLEADING CAUSES OF DEATHLEGAL STATUSLIFE EXPECTANCYLIFE EXPECTANCY AT BIRTHLIVE BIRTHSLIVING CONDITIONSLIVING STANDARDSLOCAL CAPACITYLOCAL GOVERNMENTSLONG-TERM CAREMARKETINGMEDIA ATTENTIONMEDICAL BILLSMEDICAL CAREMEDICAL CONTACTSMEDICAL EDUCATIONMEDICAL EQUIPMENTMEDICAL SERVICESMEDICINESMINISTRY OF HEALTHMODERNIZATIONMORBIDITYMORTALITYNATIONAL HEALTHNATIONAL HEALTH INSURANCENATIONAL HEALTH INSURANCE FUNDNUMBER OF PEOPLENURSESOBESITYOPEN SOCIETYOUTPATIENT CAREOUTPATIENT SERVICESPACEMAKERSPATIENTPATIENT RIGHTSPATIENT SATISFACTIONPATIENTSPERSONS WITH DISABILITIESPHARMACEUTICAL MARKETINGPHARMACEUTICAL POLICIESPHARMACEUTICAL SECTORPHARMACIESPHARMACISTSPHYSICIANPHYSICIANSPOCKET PAYMENTPOCKET PAYMENTSPOLICY DEVELOPMENTSPOLICY DIALOGUEPOLICY GOALSPRICE CONTROLPRIMARY CAREPRIMARY CARE DOCTORSPRIMARY CARE SECTORPRIMARY HEALTH CAREPRIVATE HOSPITALSPRIVATE SECTORPROFESSIONAL ASSOCIATIONSPROGRESSPROVIDERS OF HEALTH CAREPUBLIC CONTRACTPUBLIC EXPENDITUREPUBLIC EXPENDITURE ON HEALTHPUBLIC HEALTHPUBLIC HEALTH CAREPUBLIC HEALTH EXPENDITUREPUBLIC HEALTH STATISTICSPUBLIC HOSPITALSPUBLIC SECTORQUALITY ASSURANCEQUALITY IMPROVEMENTQUALITY OF CAREQUALITY OF HEALTHQUALITY OF HEALTH CAREQUALITY OF LIFEQUALITY SERVICESREIMBURSEMENT RATESRESEARCH INSTITUTIONSRESPECTRESPITE CARERICHER COUNTRIESRISK FACTORSRURAL AREASSCREENINGSERVICE DELIVERYSERVICE PROVISIONSMOKINGSOCIAL POLICYSOCIAL WORKERSSURGERYTEACHING HOSPITALSTRAUMATREATMENT SERVICESTUBERCULOSISUSE OF RESOURCESVACCINE COVERAGEVASCULAR DISEASESWORKERSWORLD HEALTH ORGANIZATIONYOUNG PEOPLEWorld Bank10.1596/16082