Specific country information sheet – Bulgaria

The activities include:

• Examining the structure, management, operation and organisation of medical services in hospitals
• Examining the compliance with the patient rights in hospitals
• Examining the compliance with medical standards in hospitals
• Monitoring the quality of medical services in accordance with established medical standards.
• Examining the hospital expenditure mechanisms in the light of  the funds allocated from the state budget.
• Taking measures to  prevent corruption in hospitals.

Monitoring the provision of basic healthcare package covered by the National Health Insurance Fund/Regional Health Insurance Fund, and the provision of health services defined by contracts concluded between insurers and service providers

NAMRB’s activity is focused on three main areas:

• Representation of municipalities in front of the central government: research, analysis, evaluation and development of proposals for change and improvement of policy at local government level; lobbying; 
• Provision of support to municipalities in executing their powers: studying municipal opinions and developing consensus and strategies; providing a wide range of consulting services and training programmes; issuing thematic and advisory guides; providing its own training centre for municipalities; 
• Participation in Bulgarian and international forums; and organisational strengthening of NAMRB.

Medical University – Plovdiv – https://mu-plovdiv.bg

Medical University – Pleven – http://mu-pleven.bg

Faculty of Medicine at Thracian University – Stara Zagora – http://uni-sz.bg/truni3/

Faculty of Medicine at Sofia University “St Kliment Ohridski” – http://shorturl.at/acCEV

Since 1999, the National Health Map (NHM) has been regulated by the Law on Health Care Establishment as a planning instrument to guarantee accessibility to health services. Population health needs are also considered on a regional level.  In 2015, the Minister of Health officially approved the elaborated  NHM methodology, which includes national benchmarks for the availability of GPs, specialist and hospital beds, and accounts for region-specific characteristics and national health priorities (such as maternal and child health, leading causes of deaths). By then, the NHM was seen as an instrument to national health policy. The Council of Ministers approved the latest version of the NHM in May 2018. The fourth version encompasses additional nursing professionals in outpatient care.

National Health Map 2018 http://www.mh.government.bg/bg/politiki/nacionalna-zdravna-karta/

Methodology for the elaboration of district health map; http://www.kj.government.bg/2015/Metodika_izrabotvane_obl_zdravna_karta.pdf

Every year the Council of Ministers approves the number of admissions for undergraduate and graduate training according to academic capacities, and needs of the professional fields and specialties. The Council decides based on a proposal by the Minister of Education and Science as well as proposals by the respective universities. 

The Regional Health Inspectorates (representatives of the Ministry of Health at regional level), together with professional associations and the Supreme Medical Council, explore the needs of medical and non-medical specialists and propose the annual number of postgraduate students to be admitted to medical schools. Following the goals and priorities of the national health strategy, the Minister of Health annually determines the number of quotas for postgraduate training in specialties subsidised by the state. The Minister of Health is also responsible for planning, coordinating and controlling postgraduate training activities for the acquisition of a medical specialty.

According to the Health Act, every physician, dentist, pharmacist, nurse, midwife, and associated medical specialist have to take part in continuous education and qualification courses. Courses are organised by the professional organisations and are provided by accredited organisations (i.e., Bulgarian Red Cross and Medical Universities). The professional organisations are responsible for coordinating, controlling the courses and for registering the participation of their members. 

The implemented measures aim at ensuring sustainable development of human resources, efficient organisation, coordination and management, financial sustainability of the system of emergency medical care, etc. The remuneration of emergency care professionals is to be increased twice during the period.

In 2015, employees in the emergency medical care system benefited from a 20% increase of remuneration. As a result of this measure, there is currently a significant increase in the number of newly recruited employees.

The methodology sets the share of hospitals’ income distributed to the health professionals at the minimum of 50%. It also defines the proportion of salaries for the different types of health workforce(physicians, nurses, non-medical professionals). The policy aims to achieve a more equitable distribution of the hospitals’ salary budgets and to increase the remuneration of nurses. The Ministry of Health and professional associations took further steps in order to make this methodology mandatory for all hospitals contracted by the National Health Insurance Fund.