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Impact of health reforms on child health services in Europe: the case of Bulgaria
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Rechel, Boika, Spencer, Nick, Blackburn, Clare, Holland, Richard and Rechel, Bernd (2009) Impact of health reforms on child health services in Europe: the case of Bulgaria. European Journal of Public Health, Vol.19 (No.3). pp. 326-330. doi:10.1093/eurpub/ckp027 ISSN 1101-1262.
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Official URL: http://dx.doi.org/10.1093/eurpub/ckp027
Abstract
Background: In the last two decades, all countries in Europe have embarked on substantial health reforms, introducing new models of financing and provision of health services. Using Bulgaria as a case study, this article examines the impact of the reforms on child health services. Methods: This is the first of a series of papers drawing on a broader research on inequalities in access to child health services, using Bulgaria as a case study. Multiple methods and data sources were used, including a review of the literature and existing epidemiological data, 50 qualitative in-depth interviews and an analysis of regulatory documents. This article presents the findings of the documentary analysis. Results: Primary health services for children are now provided by general practitioners. Children are exempted from health insurance contributions and user fees and are formally entitled to free health care. During the first years of the reform general practitioners still had insufficient training in child health. Restrictions on the number of referrals to paediatricians and discontinuation of community services at a time when general practice was not well established, undermined access to quality care. Conclusion: While many of these issues have been subsequently addressed, the reform process was far from linear. Challenges remain in ensuring access to quality child health services to the rural population and marginalized groups, such as the Roma minority and children with disabilities. Throughout Europe, health reforms need to be based on solid evidence of what works best for improving quality of and access to child health services.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine | ||||
| Divisions: | Faculty of Social Sciences > School of Health and Social Studies | ||||
| Journal or Publication Title: | European Journal of Public Health | ||||
| Publisher: | Oxford University Press | ||||
| ISSN: | 1101-1262 | ||||
| Official Date: | June 2009 | ||||
| Dates: |
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| Volume: | Vol.19 | ||||
| Number: | No.3 | ||||
| Number of Pages: | 5 | ||||
| Page Range: | pp. 326-330 | ||||
| DOI: | 10.1093/eurpub/ckp027 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access | ||||
| Funder: | Economic and Social Research Council (Great Britain) (ESRC) |
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