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Health Economics and Management

The European principle „rehabilitation–integration–return to the labor market“ and disability assessment

Paraskeva Mancheva


Introduction: The restoration of the working ability with a definite period of employment is enshrined in the definition of the Expert Committee of Rehabilitation at WHO (1958). In Bulgaria, the Territorial Expert Medical Committees (TEMCs) only carry out a medical assessment of disability, and the social assistance based on it is the Social Assistance Agency’s commitment. The purpose of this article is to explore the importance of the expert decision (disability assessment) for the implementation of the principle „rehabilitation-integration-return to the labor market“.
Material and Methods: The opinion of 612 patients with disabilities, certified/re-certified by General TEMC (St. Marina Hospital, Varna), was examined. The extract represents 10.2% of those who passed through the Commission in 2017 and was formed in accordance with the inclusion and exclusion criteria.

Research Tool: Questionnaire with 15 questions, 13 of which are closed-ended and the other 2 are open-ended. They are organized in the following areas: „organizational and methodological“, „social“, „medical“, „legal“ and „opportunities for change“.
Results and Discussion: The analysis of the demographic indicators of the persons included in the given extract allows us to get an idea of the characteristics of this vulnerable group in Varna region’s society. 85.9% of them are persons of working age (16 to 65 years), 64.1% are married, 59.6% are living in a regional city and 40.5% are without employment . Only 4.4% (n = 612) of the persons with a TEMC-determined invalidity/ disability considered rehabilitation sufficient. 81.9% (n = 209) of those who were denied a disability rate during their last re-certification reported that they were not advised to rehabilitation.
Conclusion: The study of the principle „rehabilitation-integration-return to the labor market“ under the current Bulgarian legislation reveals a number of problems that do not allow its implementation. In Bulgaria, the activity of TEMC is oriented towards determining the medical assessment of disability without the possibility of introduction to mandatory rehabilitation and control afterwards.


ability to work; rehabilitation; disability

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