title: Patient charges for health services: the opinions of healthcare stakeholders in Bulgaria.
abstract: The reforms of the Bulgarian healthcare sector have been widely discussed, both nationally and internationally. In spite of the reforms, problems with the efficiency, equity and quality in healthcare provision continue to exist in Bulgaria. Among others, the reforms included the implementation of formal patient charges for the use of healthcare services. These were established in the country in 2000. Formal patient charges are applied to all levels of medical services with the exception of emergency care. The aim of this paper is to describe and analyze the attitudes of Bulgarian healthcare stakeholders toward patient charges. The analysis is based on data collected in focus group discussions and in-depth interviews carried out in Bulgaria in May-June 2009. The paper concludes by recommendations for policies related to patient payments. The social sensitivity of these payments requires broad discussion before policy decisions are implemented. There is also a need of a well-thought communication strategy on the issue of patient payments by the Ministry of Health.
authors.affiliation: Department of Economics and Healthcare Management; Faculty of Public Health, Medical University, Varna, Bulgaria.|Department of Health Services Research; CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Elka
authors.initials: E
authors.lastname: Atanasova
authors.affiliation: Department of Health Services Research; CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.affiliation: Department of Economics and Healthcare Management; Faculty of Public Health, Medical University, Varna, Bulgaria.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Moutafovа
authors.affiliation: Department of Economics and Healthcare Management; Faculty of Public Health, Medical University, Varna, Bulgaria.
authors.forename: Todorka
authors.initials: T
authors.lastname: Kostadinova
authors.affiliation: Department of Health Services Research; CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.|Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
mesh_terms: D000288:Administrative Personnel; D001291:Attitude of Health Personnel; D002031:Bulgaria; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D005251:Fees, Medical; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration
keywords: Bulgaria; health services; healthcare stakeholders; official patient charges