Closer to the doctor

World Bank experts believe that the need for restructuring is overwhelming, but that until now it has been unclear how to implement it. The document says that the process must be undertaken in accordance with people’s needs, location and demographics. New and high criteria must be incorporated, quality of service has to be improved drastically, and all patients assured access to a medical facility and effective treatment within 30 minutes of placing a distress call, at up to 60km from the establishment.

The report’s idea is to cut the number of hospitals providing active treatment by half and keep only those offering high quality services. The plan is to keep regional hospitals and most university hospitals. A hospital providing active treatment should handle a minimum of 1000 operations and 600 births a year, the report also says. The problem is much more serious with the 91 municipal hospitals. Most of them receive no funding from their respective city halls but only from the NHIF, although their medical services are not up to scratch.

The answer to this problem is that many of these hospitals will either have to get more funding from municipalities, or be privatised, or turned into hospices and clinics for additional treatment.

The project lobbies for the sharp reduction of specialised hospitals and for those remaining to be restructured or amalgamated within multi-profile establishments and university hospitals.

Currently, there are 68 private hospitals, most of which are specialised, for small surgeries, gynaecological care and internal diseases. Large multi-profile private hospitals, with one or two exceptions, are non-existent. Most private hospitals have between 15 and 30 beds, but according to the report they must be upgraded. They must also provide a wider variety of services and conform to European standards and requirements.

This way, the strategy aims to weed out the vital establishments from the superfluous. In light of the ever aging Bulgarian population, the strategy aims to create hospitals able to accommodate people needing long-term and additional treatment. Hospitals also need to improve their social welfare services because most patients do not always need to be admitted for treatment.

Currently, there are 4.97 such beds in the country for every 1000 people. In Europe’s most developed countries, the ratio is 42 for every 1000. The initial plan proposes for Bulgaria to have 11 beds for long-term treatment for every 1000 people, and with the overall restructuring of the medical system the number of admitted patients a year is expected to be slashed by 300 000 down to 1.4 million, or 190 people for every 1000.

*Kapital weekly, Issue 34