1

Reform through ObjectivesReform in the Healthcare System

Reforming the SystemWhy do we do it?

Healthcare is a system of medical and non-medical (political, economic, social and other) events, undertaken by society for preservation and improving populations health in a specific countryWorld Health Organization

I.e. the meaning of existence and the final purpose of the healthcare system is:The best possible health for all citizens

Where are we now?

Bulgaria takes the first place for unfavorable main health and demographic indexes from all member-countries of the European Union.

Health indexes:Demographic characteristics, incl.:Death ratesInfant mortalityLife durationLife duration in good healthMorbidity and Illnesses Inability to workBulgarias population decreasesIn the end of 2013 Bulgarias population was 7245667 people, and compared to 1990 it decreased with 1423 633. Since 1990 the country has negative population growth.

Birth rate indexes, total death rates and population growth ( on 1000 people)Birth ratesDeath ratesPopulation growth6Bulgarias population grows old

The relative share of the people 65+ years in 1970 was 9.7%, and in 2013 it was 19.5% of the population.Per centAbove working ageIn working ageUnder working age7Bulgarias population lives lessBulgarias population dies more

Standardized indexes for death rates according to all reasons for death932/100 000582/100 000Per 100 000 populationBulgariaEuropean UnionYears

9Bulgarians die from:These 5 classes of illnesses cause 92% of the death cases in the country.

Circulation organs diseases 65.1%Neoplasms 17.5%Others 10.5%Diseases of the digestive system 3.5%Diseases of the respiratory system 3.4%10Death rates from circulation organs diseases

591211On population of 100 000BulgariaEuropean UnionYears11

Death rates from ischemic heart disease

10577On population of 100 000BulgariaEuropean UnionYears

12Death rates from cerebrovascular disease

16049On population of 100 000BulgariaEuropean UnionYears

13Death rates from diabetes

1311On population of 100 000BulgariaEuropean UnionYears14Death rates from malignancies

166155On population of 100 000BulgariaEuropean UnionYears

15Children in Bulgaria die more

7,84of 1 000 live-bornBulgariaEuropean UnionYears

16Perinatal infant mortality rate

611On 1 000 bornBulgariaEuropean UnionYears17Neonatal children mortality rate

4,52,7On 1 000 live-bornBulgariaEuropean UnionYears

18Probability of death up to 5 years of age(the indicator considers the probability of how many from 1,000 live-born children will die by age 5)

10,24,8On 1 000 live-bornBulgariaEuropean UnionYears

19Children in Bulgaria die from:

Children who died by the age of 1 by reasons in 2013 boysInjuries, poisoning and some other consequences of external causes 1.1%Symptoms, indexes and deviations from the norm, discovered during clinical and lab researches, not classified elsewhere 3.2%Others 7.7%Circulation organs diseases 8.5%Respiratory system diseases 10.2%Congenital anomalies development vices), deformations and chromosome aberrations 21.2%Some conditions which occur during the perinatal period 48.1%Children who died by the age of 1 by reasons in 2013 - girlsInjuries, poisoning and some other consequences of external causes 1.9%Symptoms, indexes and deviations from the norm, discovered during clinical and lab researches, not classified elsewhere 2,4%Others 9,3%Circulation organs diseases 8.7%Respiratory system diseases 11,7%Congenital anomalies development vices), deformations and chromosome aberrations 16,5%Some conditions which occur during the perinatal period 49,5%20Bulgarias population pays more and more for health

Average expense in BGN per household and per person for healthcareExpense for healthcare per householdExpense for healthcare per one personYears21Public money for healthcare is getting moreThe conclusion:We pay even more money for less health!

We lose more from bad health:In 2013 the death cases of people in working age (20-65 years) from the 4 classes of diseases the most frequent reason for death are 18 828, incl. :9 952 from circulation organs diseases;6 482 from cancer diseases;941 from respiratory system diseases;1 453 diseases of the digestive system.

In 2013 every working person has BGN 5 199 from the current volume of the GDP of the country. Unrealized benefits for the GDP for 2013 as a result of the death of these persons can be calculated to BGN 97 886 772.

Healthcare in Bulgaria doesnt achieve its main objective better health for the citizens!

5 national healthcare objectives:Integrated prophylaxis, early diagnosis and effective treatment of diseases and disabilities among:children from 0-1 years in order to decrease the mortality with 20% for a 10 year period (up to 6.8 in1000 live-born children in 2020); children from 1-9 years in order to decrease mortality with 20% for a 10 year period (up to 0.24 in1000 in 2020);teenagers and young people from 10-19 years in order to decrease mortality with 20% for a 10 year period (up to 0.32 in 1000 in 2020);people in economically active groups from 20-65 years in order to increase their work abilities and to decrease mortality with 20% for a 10 year period (up to 4.19 in 1000 in 2020);Old people above 65 years in order to increase with 20% the average future life duration of the people after becoming 65 years old (to 15.6 years in 2020).

Regrouping resources in accordance with the objectives:

Regrouping activities;Regrouping financial resources;Regrouping structures;Regrouping human resources.

1. Regrouping activities:

Implementation of:Main/basic set of healthcare activities, directed towards prophylaxis, diagnosis and treatment of the main diseases and conditions causing death and loss of work ability; maternal and child health;Also will be regulated:Additional set of healthcare activities allowing resource planning;Emergency set of healthcare activitiesExpanding the scope of activities, conducted in primary healthcare;Integrating activities of outpatient and emergency medical assistance and medical and social services;Increase in activities performed outside the hospital ambulatory activities, one-day surgery, outpatient activities, home cares, medical and social cares;Creating conditions for intensification of hospital activities, supported by development of structures for long-term treatment and care.

2. Regrouping financial resources

by sets of healthcare activities main and additional, emergency;by types of medical assistance primary, outpatient, specialized outpatient, inpatient;by referral promotion, prophylaxis, screening, diagnosis and treatment;by types provided for persons and insurance payments increase of installments for persons insured by the state, increase of collectiveness of health insurance installments, development of health insurance.on the grounds of results and quality of medical assistance.

Basic setPrevention;Diagnosis and treatment of diseases that are the most common cause of death and disability in the outpatient and hospital care;maternal and child healthHospitalPatientEmergency set

Life-threatening emergency conditionsAdditional setDiagnosis and treatment of disease outside the scope of the basic setList of waiting peopleEmergency conditionsPossible sources of financingState budgetNHIFSOIFinancing sets of healthcare activities

New policy on medicinesObjectives:

Quality, safety and efficiency of medical products;Access providing sufficient availability and accessibility to medicines;Regional use development and affirming pharmacy and therapeutic manuals and conducting therapy with medicines with proven efficiency;Guaranteeing sustainability and predictability of expenses on medicines.

Mechanisms for restriction of the unjustified increase of expenses for medicines, incl.:reimburse policy which is objectives oriented;implementation of digital platform for delivery of medicine products for hospitals;development of capacity for evaluation of health technologies;progeneric medicine policy; usage of innovative medicines after provided financial stability and predictability through needs and proven efficiency.

3. Regrouping structures3.1. Implementation of obligatory National Healthcare Card: accounting populations needs of medical assistance by types in accordance with age structure, illnesses, morbidity, death rates, child death rates, etc.;creating obligatory minimum and maximum requirements for territory distribution of structures for outpatient, inpatient, and emergency medical assistance, high-tech medical activities;regulating the investment possibilities and access to public resources in the healthcare system

When developing NHC for hospital assistance and high-tech medical activities, the model of moderate polycentrism, corresponding to the principles of regional development up to 2020 will be complied with.Urban model "moderate polycentrism" 2020National concept for spatial development of the Republic of Bulgaria for the period 2013-2015Source of information NCTD researchesLevel 1 - CapitalLevel 2Level 3 to 2 (According to the final state)Level 3Level 4 to 3 (According to final state)Level 4Level 5 to 4 (According to final state)Level 5

On national level development of the capital as a city of mega European level is combined with successful development of a limited number of centers of second hierarchy level with national significance. These are Varna, Plovdiv, Burgas, Ruse, Stara Zagora and Pleven. A group of middle cities show potentials to join the second hierarchy level Vidin, Vratsa, Gabrovo, Veliko Tarnovo, Shumen, Dobrich, Sliven, Yambol, Haskovo, Pazardzhik, Blagoevgrad, Pernik, Kyustendil. Targeted regional policy should be directed and to cooperate for the development of Veliko Tarnovo and Blagoevgrad, taking into account their strategic location in the national territory, as regional cities balancing the development. On district level, some district cities have centers, balancing the spatial development, by developing well, despite having decreased demographic potential. A sufficient number of cities from 4th level, by using specific local resources and traditions, develop successfully with significance for group of municipalities and have a role in strengthening the development of peripheral rural areas. Serious presence among them have tourist centers. The intensive development of the capital, combined with development of a small number of urban centers from 2nd and 3rd level, as well as stabilizing sufficient number of centers from 4th level is typical for this scenario, which leads to comparatively small increase in central territories and decrease of periphery, as well as to bringing urban services to rural areas. 35NHC will provide:Improvement of populations access to quality healthcare services;Optimizing the structure of hospital network;Planning of public and private investments in the healthcare system on the grounds of objective needs;Improving effectiveness of public expenses

Time framework: Obligatory nature of NHC through changes in the Law on Hospital Institutions January 2015;Development of National Health Card March 2015, including:- 28 district health cards;- Card of emergency medical assistance- Card of highly specialized medical activities; Approval of NHC by the Council of Ministers April 2015

3.2. Implementation of obligatory accreditation of hospitals through transparent and objective assessment system of:StructureProcessesResults on the grounds of:improved medical standards ;criteria and indicators for quality of medical activities;system for evaluation of patient satisfaction.4. Regrouping human resourcesPlanning on the grounds of the needs of medical assistance;Implementing new personnel categories for the healthcare system doctors assistants, paramedics;Orienting the medical education to changing needs; Mitigating the specialization conditions for doctors and other medical specialists;Development of the system for continuing education in the healthcare system;

Development of new skills conducting services in medical and social teams, new forms of servicing, encouraging empowering the patient;Implementing new model for payment of those working in the healthcare system, related to educational and qualification degree and achieved results.

More:Concept for development of the system for emergency medical attention November2014Concept for electronic healthcare December 2014Set of legislative changes with short-term measures for stabilizing the healthcare system December 2014Updating the National Healthcare Strategy and Action Plan January 2015Set of legislative measures with long-term measures for stabilizing the healthcare system January 2015.New model of medical expertise March 2015Concept and Plan for reconstruction of the system for hospital assistance April 2015.

The objective this is a dream which has a set term!

Thank you for your attention!