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Scripta Scientifica Medica

Bulgarian hospital reform and the new public management model. A change of role of state or a change of mind?

Benoît Nautre, Mila Georgieva


Nothing is simple in planning, financing, and delivering health care. Whatever changes in the system, it has both anticipated and unexpected consequences, which may be positive or negative. This makes reforming health care extremely challenging. Reforming the hospitals in Bulgaria is a difficult task, especially combined with the difficult transition process in all countries of Eastern Europe and the tendencies like growing costs of care, ageing of the population, higher levels of chronic disease and disability, increased availability of new treatments, rising public expectations, increased pressure to spend more on health care and use the available resources more efficiently. The present work uses the example of hospital change process started in newly accepted in EU European countries, particularly in Bulgaria, and proposes discussion about the potential of the New Public Management model as a mean of improvement the capacity of state to adopt the contractual approach of regulation. In conclusion, we stress that if the control by state was not the best solution, market regulation have also some limits so there could be a third way - the supervised competition a possible cure for the success of hospitals and health care reform in Bulgaria.

Scripta Scientifica Medica 2013; 45(4): 20-30.

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About The Authors

Benoît Nautre
Général Groupe Hospitalier Saint Augustin

Mila Georgieva
Medical University of Varna

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