Specialized outpatient medical care in bulgaria - state and prospects

Abstract

Following the implementation of medical system with Gen- eral Practitioners, the access of outpatient medical care spe- cialists in our country is performed after obtaining a medical referral for a specialist. National Health Insurance Fund / NHIF / performs the payments for the medical service to the specialized medical care contractor for the person having mandatory medical insurance, referred by the primary care contractor for the performance of and / or specialized outpa- tient medical care, concluded a contract with the NHIF. Implemented regulation of the access is also the main fi- nancial regulatory mechanism introduced of the closed health system in Bulgaria. Most frequently the in the policy for deterrence of insurance costs in the world and Europe are applied closed systems for payment of the medical ser- vices. On the other hand, the policy of cost sharing among insured persons has been expanding by the greater partici- pation of citizens and patients in the payments and cus- tomer fees at the time of consumption.
In Bulgaria, access to specialized care is legally regulated by the Health Act, the Health Insurance Act and the Ordi- nance on the right of access to healthcare services. The ac- cess is based on the principle of free choice of hospital pa- tients for primary, specialized and hospital care throughout the country, on the other hand, it is regulated in its part of Specialized outpatient medical healthcare by the means of referrals - for consultation or research.
NHIF has available a fixed budget established by law and in case the doctors perform more medical checkups, a deficit of funds for payment occurs. In the depleted number of refer- rals each insured person may be deprived of the opportunity to be examined and obtain the necessary medical care from the budget, where he performed regular payments. Health Insurance Act guarantees free access to medical care of the insured and the right of patient choice should not be limited in geographical or the administrative aspects.
Patients are constantly complaining that the referrals are in- sufficient in number. On the other hand, they often want to be examined by a specialist, without any objective reasons for this, and do not enable their doctors to determine whether there is an objective need for such a checkup.