Norwich Medical School, University of East Anglia, Norwich, UK.
BMC Health Serv Res. 2011 Sep 17;11:219. doi: 10.1186/1472-6963-11-219.
Health reforms in Bulgaria have introduced major changes to the financing, delivery and regulation of health care. As in many other countries of Central and Eastern Europe, these included introducing general practice, establishing a health insurance system, reorganizing hospital services, and setting up new payment mechanisms for providers, including patient co-payments. Our study explored perceptions of regulatory barriers to equity in Bulgarian child health services.
50 qualitative in-depth interviews with users, providers and policy-makers concerned with child health services in Bulgaria, conducted in two villages, one town of 70,000 inhabitants, and the capital Sofia.
The participants in our study reported a variety of regulatory barriers which undermined the principles of equity and, as far as the health insurance system is concerned, solidarity. These included non-participation in the compulsory health insurance system, informal payments, and charging user fees to exempted patients. The participants also reported seemingly unnecessary treatments in the growing private sector. These regulatory failures were associated with the fast pace of reforms, lack of consultation, inadequate public financing of the health system, a perceived "commercialization" of medicine, and weak enforcement of legislation. A recurrent theme from the interviews was the need for better information about patient rights and services covered by the health insurance system.
Regulatory barriers to equity and compliance in daily practice deserve more attention from policy-makers when embarking on health reforms. New financing sources and an increasing role of the private sector need to be accompanied by an appropriate and enforceable regulatory framework to control the behavior of health care providers and ensure equity in access to health services.
保加利亚的医疗改革对医疗保健的融资、提供和监管进行了重大改革。与中东欧的许多其他国家一样，这些改革包括引入全科医生、建立医疗保险制度、重组医院服务以及为提供者（包括患者自付费用）建立新的支付机制。我们的研究探讨了保加利亚儿童卫生服务中监管公平障碍的看法。
在保加利亚的两个村庄、一个拥有 70,000 名居民的城镇和首都索非亚，对关注儿童卫生服务的用户、提供者和政策制定者进行了 50 次深入的定性访谈。
我们研究的参与者报告了各种监管障碍，这些障碍破坏了公平原则，就医疗保险制度而言，也破坏了团结原则。这些障碍包括不参与强制性医疗保险制度、非正式支付以及向豁免患者收取用户费用。参与者还报告了私营部门不断增长的看似不必要的治疗。这些监管失败与改革步伐快、缺乏磋商、卫生系统公共供资不足、医学的所谓“商业化”以及立法执行不力有关。访谈中的一个反复出现的主题是需要更好地了解患者的权利和医疗保险系统涵盖的服务。
在进行医疗改革时，政策制定者需要更加关注公平和合规方面的监管障碍。新的融资来源和私营部门的作用日益增加，需要有一个适当和可执行的监管框架来控制医疗保健提供者的行为，确保公平获得卫生服务。
