Rechel, Boika, Blackburn, Clare, Spencer, Nick and Rechel, Bernd (2011) Regulatory barriers to equity in a health system in transition : a qualitative study in Bulgaria. BMC Health Services Research, Vol.11 (No.1). p. 219. doi:10.1186/1472-6963-11-219 ISSN 1472-6963.

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Abstract

Background: Health reforms in Bulgaria have introduced major changes to the financing, delivery and regulation
of health care. As in many other countries of Central and Eastern Europe, these included introducing general
practice, establishing a health insurance system, reorganizing hospital services, and setting up new payment
mechanisms for providers, including patient co-payments. Our study explored perceptions of regulatory barriers to
equity in Bulgarian child health services.
Methods: 50 qualitative in-depth interviews with users, providers and policy-makers concerned with child health
services in Bulgaria, conducted in two villages, one town of 70,000 inhabitants, and the capital Sofia.
Results: The participants in our study reported a variety of regulatory barriers which undermined the principles of
equity and, as far as the health insurance system is concerned, solidarity. These included non-participation in the
compulsory health insurance system, informal payments, and charging user fees to exempted patients. The
participants also reported seemingly unnecessary treatments in the growing private sector. These regulatory failures
were associated with the fast pace of reforms, lack of consultation, inadequate public financing of the health
system, a perceived “commercialization” of medicine, and weak enforcement of legislation. A recurrent theme from
the interviews was the need for better information about patient rights and services covered by the health
insurance system.
Conclusions: Regulatory barriers to equity and compliance in daily practice deserve more attention from policymakers
when embarking on health reforms. New financing sources and an increasing role of the private sector
need to be accompanied by an appropriate and enforceable regulatory framework to control the behavior of
health care providers and ensure equity in access to health services.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Social Sciences > School of Health and Social Studies
Library of Congress Subject Headings (LCSH):	Health care reform -- Bulgaria, Child health services -- Bulgaria
Journal or Publication Title:	BMC Health Services Research
Publisher:	BioMed Central Ltd.
ISSN:	1472-6963
Official Date:	17 September 2011
Dates:	Date Event 17 September 2011 Published
Volume:	Vol.11
Number:	No.1
Page Range:	p. 219
DOI:	10.1186/1472-6963-11-219
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	18 December 2015
Date of first compliant Open Access:	18 December 2015
Funder:	Economic and Social Research Council (Great Britain) (ESRC)

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