The distribution of health resources in Bulgaria is limited by systemic deficiencies that lead to imbalances and unequal access, with vulnerable groups affected the most, according to a report by the human rights organisation Bulgarian Helsinki Committee (BHC).
The conclusions are based on a field survey of patients, doctors, healthcare professionals, experts, and people in high positions of power in the healthcare system.
The survey aimed to establish how they feel in their daily practice and the mechanisms for allocating resources in Bulgarian healthcare.
“They all share the feeling of dissatisfaction and powerlessness,” said Nadezhda Tsekulova of the Bulgarian Helsinki Committee.
Unfair and ineffective mechanisms
The report, published on 29 November, found that in Bulgaria, vulnerable groups are often marginalised, and their access to healthcare depends more on the individual commitment of medical professionals than on systemic mechanisms.
“Everyone – from patients who enter the healthcare system without personal acquaintances to those people who have held or hold the highest management positions – share the feeling that the mechanisms for distributing the health resource are not fair enough and ineffective,” Tsekulova commented.
In healthcare, “vulnerable groups” are communities or individuals at greater risk of health problems due to social, economic, geographic, cultural, or other factors.
These people often face barriers to accessing medical care, treatment or preventive services. Vulnerable groups may include people with low incomes, people without health insurance, migrants, the elderly, children, people with chronic diseases, rare diseases or disabilities, and members of minority ethnic communities.
Catastrophic health expenditure
The BHC decided to prepare the report after the Bulgarian Health Ministry’s distribution plan for the extremely limited initial number of vaccines against COVID-19 during the pandemic. The organisation has subsequently started legal procedures against the Ministry on this issue.
In the Bulgarian vaccination plan against COVID-19, the elderly and people with chronic diseases were placed after young and healthy people.
Eurostat data confirms the basis for social and economic exclusion in the EU’s poorest member state. The data show that Bulgaria ranks third in the EU regarding the number of deaths from treatable diseases.
At the same time, Bulgaria has the highest level of catastrophic health expenditures in the EU. Medical spending, excluding long-term care, accounted for 4.4% of final household consumption in Bulgaria – the largest share among EU countries with data available, according to Euractiv research.
Catastrophic expenditure is defined as household spending for health care exceeding 40% of total household spending on subsistence needs.
“This lack of financial protection and excessively high household spending on health, risks pushing poor households towards or further into poverty,” claims a Eurostat report on the state of the Bulgarian health system.
In 2018, roughly 19% of Bulgarian households reported having incurred catastrophic health spending – the highest level in the EU in recent years and nearly three times the EU average.
Approximately two-thirds of all catastrophic spending in Bulgaria is concentrated among the poorest households, which is proportionally more than in other countries with high levels of catastrophic spending, such as Lithuania and Latvia.
Discrimination
Medical professionals told the BHC on condition of anonymity that they face administrative pressure to cut costs, which may be against the patient’s best interests.
At the same time, patients themselves define any consideration of not allowing people to receive treatment due to a patient’s “lack of perspective” as unethical and subjective.
“We must admit that the system in our country is inefficient and unfair and think about how to turn the majority of good practices, which are the result of individual efforts of individual medical specialists, into a streamlined system,” Tsekulova commented.
The report commented with “particular concern” on the growing acceptance of discriminatory practices regarding access to medical care for people from the Roma minority.
“For access to the health system, it matters whether the patient is a child or an adult. Ethnicity matters. Social status matters, but not only. It also matters whether you have a high chance or potential as a patient because, in severely disabled patients, no one would want to invest,” a health mediator quoted in the report.
Antoineta Ivanova, a civil activist for healthcare rights, commented that the “rules” of the healthcare system should not be more important than people’s rights.
Among the recommendations in the BHC report are the introduction of transparent mechanisms for allocating resources based on data, evidence, clear medical criteria and public dialogue, strengthening the participation of citizens, patients, vulnerable groups and different professional levels in the decision-making process.
[Edited by Vasiliki Angouridi, Brian Maguire]
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Publish date : 2024-12-19 15:56:00
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