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Изследване на влиянието на директните плащания от пациентите с артериална хипертония върху достъпа до ефективни лекарствени терапии в област Плевен

Надя Велева, Галина Дякова


Introduction: Arterial hypertension (AH) is among the most common chronic diseases in Bulgaria and in the Pleven region. AH maintenance therapy is funded both by the National Health Insurance Fund and the patients with increasing out-of-pocket payments from the latter.

Aim: The aim of this paper was to study the effect of out-of-pocket payments for АH drugs on patients` access to effective therapies in the Pleven region.

Materials and Methods: A sociological survey of 648 clients in 15 pharmacies in the Pleven region was conducted from 01.10.2015 to 01.10.2016. The self-administered questionnaire included questions about drug prices, out-of-pocket payments, reasons for change of the prescribed therapy, etc. Regional Health Inspectorate data concerning drug therapies of 1127 patients with AH (IDC I10,I11,I12,I13) were analyzed too.

Results: Most patients were above 60 years of age (51.70%) and retired. Most out-of-pocket payments were in the range 30-40 BGN (46.29%) and 40.42% of them were made by respondents with a mean income of 300 BGN per month. The highest share of changed therapies (43.04%) and the highest share of discontinued therapies (23.69%) were found for the cost range 20-40 BGN.

Conclusions: Increased out-of-pocket payments are a barrier to the access to treatment for AH, primarily affecting vulnerable populations, such as those on low incomes and pensioners in the Pleven region.


hypertension drugs; out-of-pocket payments; access

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