Healthcare in Bulgarian Regions
Since 2012 the Institute for Market Economics investigates the condition and development of socio-economic processes on a regional level in Bulgaria. The current analysis looks at the condition of some aspects of the healthcare system in the country, as well the population’s satisfaction with the provided services.
There are two main conclusions that stand out as result of our analysis of regional healthcare systems and the our two nationwide surveys. The first one is the huge differences between the access of the population to doctors, medical professionals and healthcare infrastructure, which raises questions about the accessibility of health services and their efficiency. The second conclusion is that the presence of more hospital beds per capita, more doctors, nurses, emergency teams etc., does not necessarily mean higher quality of healthcare and better satisfaction with the services that are provided.
Judging by the number of beds in Multiprofile Hospitals for Active Treatment (MHATs) per 10 000 people in the different regions in 2012, the best acess to medical services is in Montana, Pleven and Targovishte, and the worst – in Bourgas, Pernik and Blagoevgrad. At the same time in some regions, such as Montana, the big number of hospital beds is focused in a small number of MHATs, which restricts the access of the population to hospital services. At the same time Bourgas has one of the lowest hospital-beds-to-population ratios, but is characterized by relatively high number of hospitals, which improves the access to healthcare.
In most regions there are similar ratios between doctors and population, but the difference between the regions with the least and the most specialists are significant. This difference can be as big as 4 times in the internal diseases specialists and orthopedics in 2012. If we take a look at pediatricians, in Sofia-Capital there are three times as many specialists as the second best region – Gabrovo, and nearly 29 times as much as the region with the least amount of these specialists – Sofia-Province. The data for the relatively high amount of pediatricians in Gabrovo in 2012 is surprising, when taking into account that the region has one of the worst demographic conditions.
There are big differences in the subject of availability of medical personnel, such as doctor’s assistants. At the same time there are differences present with the nurses and lab assistants, but the differences between different regions as well as between the regions with the highest and lowest number of nurses and lab assistants per capita are significantly lower.
The data for the presence of emergency medical teams shows, that in 2010 some of the least populated areas have the highest number of EMTs per 100 000 people, while densely populated regions, such as Sofia-Capital and Plovdiv have the lowest proportion of emergency medical teams per capita, while at the same time top the charts in teams per 1000 sq. km., which points towards the presence of significant inefficiencies within the emergency medical care system.
Besides objective data for the condition of health care supply on a regional level, a lot of questions are raised by the sociological research on population health care satisfaction, which IME is performing in the past several years. It shows that regions with similar indicators for hospital beds and medical personnel have completely different service quality ratings. Such examples are Kiustendil, Haskovo, and Ruse, where the healthcare infrastructure is comparable, but in 2012 only 8.3% of respondents would qualify the healthcare services as good, compared to 35.4% in Haskovo and 68.1% in Ruse. In other words, the presence of good healthcare infrastructure (high number of hospitals and beds) and medical personnel is a prerequisite for better accessibility of the health care service, but not a quality and patient satisfaction guarantee.
Noteworthy is also that often a high percentage of lower ratings of the healthcare system goes hand in hand with high corruption perception. Such negative examples are regions with big cities like Sofia-Capital, Bourgas and Plovdiv, which are amongst the “top five” in both corruption perception and the ratings of the work of the healthcare system.
Big differences between the regions, both in regards to healthcare infrastructure, as well as population ratings of health services show that the healthcare system has problems not only on national, but on regional level too. Problems are not isolated strictly to the healthcare’s access to finances and specialists, and they also decrease the quality of services, available to patients.