HUMAN DEVELOPMENT REPORT ! BULGARIA 1996
98
The regional level is made up of 30
amalgamated regional hospitals (ARH),
each one with an average capacity of 950
beds. This accounts for 31.3% of the na-
tional stock of hospital beds. The ARH
provide specialized consultations and hos-
pital medical services to the population of
the respective region (an average of 330
000) and primary medical assistance to the
inhabitants of the municipality in which the
respective hospital is located. On regional
level there are also specialized dispensa-
ries in oncology, psychiatry, dermatologi-
cal and venereal diseases, and lung dis-
eases, acounting for 6.0% of the stock of
hospital beds. Of regional and inter-re-
gional importance are the specialized hos-
pitals of one single profile (maternity and
gynaecological, of lung diseases, psychiat-
ric) accounting for 7.0% of the total stock
of hospital beds.
The municipal level includes the mu-
nicipal hospitals (MH) with outpatient
polyclinics and an average capacity of 267
beds, which account for a total of 27.6%
of the stock of hospital beds. They have at
least four specializations: therapeutic, sur-
gical, paediatric and maternity and
gynaecological. Village polyclinics with 3
to 6 doctors have been opened in the small
municipalities in the villages, along with
village health centres, health care services
centres of physicians and doctors assis-
tants. There are also dentists rooms in
them.
Workers hospitals and polyclinics pro-
vide medical services at major industrial
enterprises, having at their disposal 1.4%
of the stock of hospital beds, as well as
doctors health centres.
In the public health sector, primary
medical services are secured by the outpa-
tient polyclinic of most varied categories.
In the urban centres they are provided in
profiles by general practitioners, paediat-
ricians, gynaecologists, school and work-
shop physicians.
In the villages the physi-
cians are primarily general practitioners.
Specialized medical aid is provided in the
polyclinics of the municipal hospitals in the
main specialities, in the polyclinics of the
amalgamated regional hospitals in an ex-
tended list of specialities and in the dis-
pensaries, in the consultation rooms of the
clinics with the medical universities and the
national medical centres. Emergency medi-
cal aid is provided by the regional centres,
and urgent health care services - by the
outpatient polyclinics.
Dental aid is secured on national level
by the clinics of the dentistry departments,
on regional level by the dentistry polyclin-
ics, and on municipal level - by the den-
tists rooms at the polyclinics of the mu-
nicipal hospitals, village and workers
health care services.
There are substantial differences in the
provision of hospital beds for the popula-
tion by regions, which is not always associ-
ated with higher or smaller needs of health
care services. The number of hospital beds
ranges between 81.8 per 10 000 of the popu-
lation (Bourgas region) and 126.0 (Lovech
region). These differences have largely
been determined by the existence of health
care establishments on the territory of the
individual regions, which have national and
inter-regional functions.
Table 8.4.
Stock of beds in the hospitals and outpatient polyclinics
per 10 000 of the population
Regions
1990
1994
Total
103.9
104.7
City of Sofia
120.0
130.9
Bourgas
81.7
79.2
Varna
99.6
98.0
Lovech
127.0
123.1
Montana
100.8
105.2
Plovdiv
96.3
90.0
Rousse
97.2
101.4
Sofia
93.8
96.0
Haskovo
109.7
112.3
99
REGIONAL PROBLEMS OF HEALTH AND OF HEALTH CARE SERVICES
While there is a high number provided
per 10 000 of the population of doctors
(33.3), dentists (6.6) and paramedical per-
sonnel (96.6), in 1994 their break-down in
regions was uneven. The provision of doc-
tors and dentists
at the health care estab-
lishments in subordination of the munici-
pal councils of the regions of Rousse and
Bourgas is considerably below the average
for the country, as is that of semi-higher
education and secondary education medi-
cal personnel in the Plovdiv and Varna
regions.
The volume of the work carried out
by the health care establishments in the
country has been decreasing during the past
few years. Fewer home visits, fewer pro-
phylactic examinations, smaller number of
people that had been taken to hospital for
treatment, fewer mothers-to-be and infants
followed up by the maternity and child care
consultations, fewer occupied hospital beds
have been registered in all regions of the
country.
The fundamental problems valid for
all regions are as follows:
- structures inadequate to meet the
needs, especially in the case of hospital
treatment, which are an obstacle for their
effective functioning;
- underdeveloped economic and finan-
cial mechanisms, stimulating the develop-
ment of the system and the quality of medi-
cal services;
- acute shortage of finances, which
stands in the way of the supply with medi-
cines, consumer supplies and the introduc-
tion of new technologies. At the same time
the available finances are not adequately
and effectively used;
- unjustified and incidental changes
with elements of voluntarism since 1990.
Featuring among them have been the re-
scinding of legislative acts, without their
having been promptly substituted by new
ones; the break off of organizational, meth-
odological and consultation interrelations
of the levels of health care services; break
of the administrative and governing order
without the establishment of the manda-
tory balance between centralization and
decentralization; the lack of legislatively
established relations between the public
Dentists provided to the population in the treatment and
preventive treatment public health establishments in
subordination of the municipalities by December 31, 1994
Figure 8.3.
Doctors provided to the population at the treatment and
preventive treatment establishments in subordination of the
municipalities by December 31, 1994.
Figure 8.2.
The changes in the
health care services
have not been guided by
a lucid strategy