IDEAS home Printed from
   My bibliography  Save this paper

Healthcare Reforms in Bulgaria: Towards Diagnosis and Prescription


  • Pashev, Konstantin


The paper studies the policy response to the market failures and challenges of healthcare in transition. Bulgaria chose a halfway shift from healthcare services provided entirely by the state to a system with private providers of outpatient services and public providers of inpatient services, both sectors financed mainly by state-run compulsory payroll insurance system. The paper shows the evolution of this reform path to low compliance by both customers (contributors) and service-providers (contractors with the National Health Insurance Fund), which leads to excessive regulations and control, and crowding out of the private sector. The outcome is a system that is increasingly driven by administrative controls at the expense of market incentives. Based on this analysis it identifies the relevant policy implications and opportunities for moving the stalled health reforms out of the institutional impasse.

Suggested Citation

  • Pashev, Konstantin, 2006. "Healthcare Reforms in Bulgaria: Towards Diagnosis and Prescription," MPRA Paper 999, University Library of Munich, Germany.
  • Handle: RePEc:pra:mprapa:999

    Download full text from publisher

    File URL:
    File Function: original version
    Download Restriction: no

    References listed on IDEAS

    1. Paul Joskow & Jean Tirole, 2007. "Reliability and competitive electricity markets," RAND Journal of Economics, RAND Corporation, vol. 38(1), pages 60-84, March.
    2. Chao, Hung-po & Wilson, Robert, 1987. "Priority Service: Pricing, Investment, and Market Organization," American Economic Review, American Economic Association, vol. 77(5), pages 899-916, December.
    3. David Besanko & Shabtai Donnenfeld & Lawrence J. White, 1987. "Monopoly and Quality Distortion: Effects and Remedies," The Quarterly Journal of Economics, Oxford University Press, vol. 102(4), pages 743-767.
    4. Rudnick, Hugh & Raineri, Ricardo, 1997. "Transmission pricing practices in South America," Utilities Policy, Elsevier, vol. 6(3), pages 211-218, September.
    5. Woo, Chi-Keung & Horowitz, Ira & Martin, Jennifer, 1998. "Reliability Differentiation of Electricity Transmission," Journal of Regulatory Economics, Springer, vol. 13(3), pages 277-292, May.
    6. Smith, Stephen A, 1989. "Efficient Menu Structures for Pricing Interruptible Electric Power Service," Journal of Regulatory Economics, Springer, vol. 1(3), pages 203-223, September.
    7. Harris, Milton & Raviv, Artur, 1981. "A Theory of Monopoly Pricing Schemes with Demand Uncertainty," American Economic Review, American Economic Association, vol. 71(3), pages 347-365, June.
    8. Spulber, Daniel F, 1992. "Capacity-Contingent Nonlinear Pricing by Regulated Firms," Journal of Regulatory Economics, Springer, vol. 4(4), pages 299-319, December.
    9. Mohan Munasinghe & Mark Gellerson, 1979. "Economic Criteria for Optimizing Power System Reliability Levels," Bell Journal of Economics, The RAND Corporation, vol. 10(1), pages 353-365, Spring.
    10. John Tschirhart & Frank Jen, 1979. "Behavior of a Monopoly Offering Interruptible Service," Bell Journal of Economics, The RAND Corporation, vol. 10(1), pages 244-258, Spring.
    11. Mark Armstrong & Simon Cowan & John Vickers, 1994. "Regulatory Reform: Economic Analysis and British Experience," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262510790, January.
    12. Paul Joskow, 2006. "Patterns of Transmission Investments," Chapters,in: Competitive Electricity Markets and Sustainability, chapter 5 Edward Elgar Publishing.
    13. Deng, Shi-Jie & Oren, Shmuel S, 2001. "Priority Network Access Pricing for Electric Power," Journal of Regulatory Economics, Springer, vol. 19(3), pages 239-270, July.
    14. Hung-po Chao & Shmuel S. Oren & Stephen A. Smith & Robert B. Wilson, 1988. "Priority Service: Market Structure and Competition," The Energy Journal, International Association for Energy Economics, vol. 0(Special I), pages 77-104.
    15. Viswanathan, Nagarathnam & Tse, Edison T S, 1989. "Monopolistic Provision of Congested Service with Incentive-Based Allocation of Priorities," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 30(1), pages 153-174, February.
    16. Chao, Hung-Po & Peck, Stephen C, 1998. "Reliability Management in Competitive Electricity Markets," Journal of Regulatory Economics, Springer, vol. 14(2), pages 189-200, September.
    17. Tan, Chin-Woo & Varaiya, Pravin, 1993. "Interruptible electric power service contracts," Journal of Economic Dynamics and Control, Elsevier, vol. 17(3), pages 495-517, May.
    18. Wilson, Robert, 1989. "Ramsey Pricing of Priority Service," Journal of Regulatory Economics, Springer, vol. 1(3), pages 189-202, September.
    19. Besanko, David & Donnenfeld, Shabtai, 1988. "Rate of return regulation and product variety," Journal of Public Economics, Elsevier, vol. 36(3), pages 293-304, August.
    20. Chi-Keung Woo & Nate Toyama, 1986. "Service Reliability and the Optimal Interruptible Rate Option in Residential Electricity Pricing," The Energy Journal, International Association for Energy Economics, vol. 0(Number 3), pages 123-136.
    21. Spulber, Daniel F, 1993. "Monopoly Pricing of Capacity Usage under Asymmetric Information," Journal of Industrial Economics, Wiley Blackwell, vol. 41(3), pages 241-257, September.
    22. Wilson, Robert B, 1989. "Efficient and Competitive Rationing," Econometrica, Econometric Society, vol. 57(1), pages 1-40, January.
    Full references (including those not matched with items on IDEAS)


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

    Cited by:

    1. 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.

    More about this item


    healthcare reform;

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:


    Access and download statistics


    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:pra:mprapa:999. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Joachim Winter). General contact details of provider: .

    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.

    We have no references for this item. You can help adding them by using 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.

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

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.