IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v102y2011i2p263-269.html
   My bibliography  Save this article

What have 10 years of health insurance reforms brought about in Bulgaria? Re-appraising the Health Insurance Act of 1998

Author

Listed:
  • Atanasova, Elka
  • Pavlova, Milena
  • Velickovski, Robert
  • Nikov, Bogomil
  • Moutafova, Emanuela
  • Groot, Wim

Abstract

This article discusses the financial reforms in the Bulgarian public health care sector. Since 1998, when the Bulgarian parliament passed the Health Insurance Act, compulsory contributions for social health insurance have become the main source of health care financing. They replaced the previous tax-based health care funding mechanism. This article reviews empirical evidence and macro indicators to analyse to what extent the expectations of this reform are achieved. Two groups of sources are reviewed: (1) publications prior to the implementation of the social health insurance in Bulgaria that discuss its potential impact; (2) publications after the insurance implementation, that investigate the actual impact of this reform. The results suggest that social health insurance in Bulgaria brought about certain efficiency improvements in the public health care sector. However, the overall social benefit of the reform is doubtful. The main reasons for this are related to the ineffective organisation of the Bulgarian public health care sector, as well as to the overall lack of financial resources for health care in the country.

Suggested Citation

  • Atanasova, Elka & Pavlova, Milena & Velickovski, Robert & Nikov, Bogomil & Moutafova, Emanuela & Groot, Wim, 2011. "What have 10 years of health insurance reforms brought about in Bulgaria? Re-appraising the Health Insurance Act of 1998," Health Policy, Elsevier, vol. 102(2), pages 263-269.
    • Handle: RePEc:eee:hepoli:v:102:y:2011:i:2:p:263-269
    DOI: 10.1016/j.healthpol.2010.12.001
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851010003647
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2010.12.001?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Balabanova, Dina & McKee, Martin, 2002. "Understanding informal payments for health care: the example of Bulgaria," Health Policy, Elsevier, vol. 62(3), pages 243-273, December.
    2. Bistra Vladimirova Datzova, 2006. "The difficult transition to national health insurance in Bulgaria," Journal of International Development, John Wiley & Sons, Ltd., vol. 18(3), pages 425-434.
    3. Pavlova, Milena & Groot, Wim & van Merode, Frits, 2000. "Appraising the financial reform in Bulgarian public health care sector: the health insurance act of 1998," Health Policy, Elsevier, vol. 53(3), pages 185-199, October.
    4. Ms. Nora K Markova, 2006. "How Does the Introduction of Health Insurance Change the Equity of Health Care Provision in Bulgaria?," IMF Working Papers 2006/285, International Monetary Fund.
    5. Pashev, Konstantin, 2006. "Healthcare Reforms in Bulgaria: Towards Diagnosis and Prescription," MPRA Paper 999, University Library of Munich, Germany.
    6. Milena Pavlova & Wim Groot & Godefridus Van Merode, 2004. "Willingness and ability of Bulgarian consumers to pay for improved public health care services," Applied Economics, Taylor & Francis Journals, vol. 36(10), pages 1117-1130.
    7. Balabanova, Dina & McKee, Martin, 2004. "Reforming health care financing in Bulgaria: the population perspective," Social Science & Medicine, Elsevier, vol. 58(4), pages 753-765, February.
    8. Borissov, Vesselin & Rathwell, Tom, 1996. "Health care reforms in Bulgaria: An initial appraisal," Social Science & Medicine, Elsevier, vol. 42(11), pages 1501-1510, June.
    9. Delcheva, Evgenia & Balabanova, Dina & McKee, Martin, 1997. "Under-the-counter payments for health care: Evidence from Bulgaria," Health Policy, Elsevier, vol. 42(2), pages 89-100, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Thijs Schoot & Milena Pavlova & Elka Atanasova & Wim Groot, 2017. "Preferences of Bulgarian consumers for quality, access and price attributes of healthcare services—result of a discrete choice experiment," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(1), pages 47-71, January.
    2. Petra Baji & Milena Pavlova & László Gulácsi & Miklós Farkas & Wim Groot, 2014. "The link between past informal payments and willingness of the Hungarian population to pay formal fees for health care services: results from a contingent valuation study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 853-867, November.
    3. Vakulenko Veronika & Mattei Giorgia, 2023. "Reforming the Public Sector in Eastern European and Former Soviet Union Countries: A Systematic Literature Review," Central European Journal of Public Policy, Sciendo, vol. 17(1), pages 55-79, June.
    4. Yuan, Yaqi, 2021. "Public satisfaction with health care system in 30 countries: The effects of individual characteristics and social contexts," Health Policy, Elsevier, vol. 125(10), pages 1359-1366.
    5. Arsenijevic, Jelena & Pavlova, Milena & Groot, Wim, 2015. "Out-of-pocket payments for health care in Serbia," Health Policy, Elsevier, vol. 119(10), pages 1366-1374.
    6. Danyliv, Andriy & Groot, Wim & Gryga, Irena & Pavlova, Milena, 2014. "Willingness and ability to pay for physician services in six Central and Eastern European countries," Health Policy, Elsevier, vol. 117(1), pages 72-82.
    7. Tambor, Marzena & Pavlova, Milena & Rechel, Bernd & Golinowska, Stanisława & Sowada, Christoph & Groot, Wim, 2014. "Willingness to pay for publicly financed health care services in Central and Eastern Europe: Evidence from six countries based on a contingent valuation method," Social Science & Medicine, Elsevier, vol. 116(C), pages 193-201.
    8. Elka Atanasova & Milena Pavlova & Emanuela Moutafovа & Todorka Kostadinova & Wim Groot, 2015. "Patient charges for health services: the opinions of healthcare stakeholders in Bulgaria," International Journal of Health Planning and Management, Wiley Blackwell, vol. 30(3), pages 232-245, July.
    9. Tambor, Marzena & Pavlova, Milena & Golinowska, Stanisława & Sowada, Christoph & Groot, Wim, 2013. "The formal–informal patient payment mix in European countries. Governance, economics, culture or all of these?," Health Policy, Elsevier, vol. 113(3), pages 284-295.
    10. Dimova, Antoniya & Rohova, Maria & Hasardzhiev, Stanimir & Spranger, Anne, 2018. "An innovative approach to participatory health policy development in Bulgaria: The conception and first achievements of the Partnership for Health," Health Policy, Elsevier, vol. 122(2), pages 81-86.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Williams, Colin C. & Horodnic, Adrian V., 2017. "Rethinking informal payments by patients in Europe: An institutional approach," Health Policy, Elsevier, vol. 121(10), pages 1053-1062.
    2. Tambor, Marzena & Pavlova, Milena & Rechel, Bernd & Golinowska, Stanisława & Sowada, Christoph & Groot, Wim, 2014. "Willingness to pay for publicly financed health care services in Central and Eastern Europe: Evidence from six countries based on a contingent valuation method," Social Science & Medicine, Elsevier, vol. 116(C), pages 193-201.
    3. Szende, Agota & Culyer, Anthony Johr, 2006. "The inequity of informal payments for health care: The case of Hungary," Health Policy, Elsevier, vol. 75(3), pages 262-271, February.
    4. Thijs Schoot & Milena Pavlova & Elka Atanasova & Wim Groot, 2017. "Preferences of Bulgarian consumers for quality, access and price attributes of healthcare services—result of a discrete choice experiment," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(1), pages 47-71, January.
    5. Sonila Tomini & Wim Groot & Milena Pavlova, 2012. "Paying informally in the Albanian health care sector: a two-tiered stochastic frontier model," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(6), pages 777-788, December.
    6. Adrian V. Horodnic & Colin C. Williams & Răzvan Ionuț Drugă & Cristian Incaltarau, 2021. "Informal Payments by Patients in Central and Eastern Europe during the COVID-19 Pandemic: An Institutional Perspective," IJERPH, MDPI, vol. 18(20), pages 1-17, October.
    7. Cherecheş, Răzvan M. & Ungureanu, Marius I. & Sandu, Petru & Rus, Ioana A., 2013. "Defining informal payments in healthcare: A systematic review," Health Policy, Elsevier, vol. 110(2), pages 105-114.
    8. Colin WILLIAMS & Ioana HORODNIC & Adrian HORODNIC, 2016. "Who is making informal payments for public healthcare in East-Central Europe? An evaluation of socio-economic and spatial variations," Eastern Journal of European Studies, Centre for European Studies, Alexandru Ioan Cuza University, vol. 7, pages 49-61, June.
    9. Sonila M. Tomini & Wim Groot, 2013. "Paying informally for public health care in Albania: scarce resources or governance failure?," Applied Economics, Taylor & Francis Journals, vol. 45(36), pages 5119-5130, December.
    10. Mæstad, Ottar & Mwisongo, Aziza, 2011. "Informal payments and the quality of health care: Mechanisms revealed by Tanzanian health workers," Health Policy, Elsevier, vol. 99(2), pages 107-115, February.
    11. Kaitelidou, Daphne Ch. & Tsirona, Christina S. & Galanis, Petros A. & Siskou, Olga Ch. & Mladovsky, Philipa & Kouli, Eugenia G. & Prezerakos, Panagiotis E. & Theodorou, Mamas & Sourtzi, Panagiota A. &, 2013. "Informal payments for maternity health services in public hospitals in Greece," Health Policy, Elsevier, vol. 109(1), pages 23-30.
    12. Line Neerup Handlos & Karen Fog Olwig & Ib Christian Bygbjerg & Marie Norredam, 2016. "Return Migrants’ Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example," IJERPH, MDPI, vol. 13(9), pages 1-12, September.
    13. Habibov, Nazim & Cheung, Alex, 2017. "Revisiting informal payments in 29 transitional countries: The scale and socio-economic correlates," Social Science & Medicine, Elsevier, vol. 178(C), pages 28-37.
    14. Gaal, Peter & Evetovits, Tamas & McKee, Martin, 2006. "Informal payment for health care: Evidence from Hungary," Health Policy, Elsevier, vol. 77(1), pages 86-102, June.
    15. Pavlova, Milena & Groot, Wim & van Merode, Frits, 2000. "Appraising the financial reform in Bulgarian public health care sector: the health insurance act of 1998," Health Policy, Elsevier, vol. 53(3), pages 185-199, October.
    16. Elka Atanasova & Milena Pavlova & Emanuela Moutafovа & Todorka Kostadinova & Wim Groot, 2015. "Patient charges for health services: the opinions of healthcare stakeholders in Bulgaria," International Journal of Health Planning and Management, Wiley Blackwell, vol. 30(3), pages 232-245, July.
    17. Tomini, Sonila & Groot, Wim, 2012. "Paying informally for public health care in Albania: scarce resources or governance failure?," MERIT Working Papers 2012-070, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).
    18. Shuey, Dean A. & Qosaj, Fatime Arenliu & Schouten, Erik J. & Zwi, Anthony B., 2003. "Planning for health sector reform in post-conflict situations: Kosovo 1999-2000," Health Policy, Elsevier, vol. 63(3), pages 299-310, March.
    19. Ligita Gasparėnienė & Rita Remeikienė & Colin C. Williams, 2022. "Unemployment and the Informal Economy," SpringerBriefs in Economics, Springer, number 978-3-030-96687-4, October.
    20. Erik Schokkaert & Jonas Steel & Carine Van de Voorde, 2017. "Out-of-Pocket Payments and Subjective Unmet Need of Healthcare," Applied Health Economics and Health Policy, Springer, vol. 15(5), pages 545-555, October.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:102:y:2011:i:2:p:263-269. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.