1. Reform through Objectives Reform in the Healthcare System

2. Reforming the System Why do we do it?

3. “Healthcare is a system of medical and non- medical (political, economic, social and other) events, undertaken by society for preservation and improving population’s health in a specific country” World Health Organization

4. I.e. the meaning of existence and the final purpose of the healthcare system is: The best possible health for all citizens

5. Where are we now? Bulgaria takes the first place for unfavorable main health and demographic indexes from all member- countries of the European Union. Health indexes: Demographic characteristics, incl.: Death rates Infant mortality Life duration Life duration in good health Morbidity and Illnesses Inability to work Health indexes: Demographic characteristics, incl.: Death rates Infant mortality Life duration Life duration in good health Morbidity and Illnesses Inability to work

6. Bulgaria’s population decreases In the end of 2013 Bulgaria’s population was 7 245 667 people, and compared to 1990 it decreased with 1 423 633. Since 1990 the country has negative population growth. Birth rate indexes, total death rates and population growth ( on 1000 people)

7. Bulgaria’s population grows old The relative share of the people 65+ years in 1970 was 9.7%, and in 2013 it was 19.5% of the population.

8. Bulgaria’s population lives less

9. Bulgaria’s population dies more Standardized indexes for death rates according to all reasons for death 932/100 000 582/100 000

10. Bulgarians die from: These 5 classes of illnesses cause 92% of the death cases in the country.

11. Death rates from circulation organs diseases 591 211

12. Death rates from ischemic heart disease 105 77

13. Death rates from cerebrovascular disease 160 49

14. Death rates from diabetes 13 11

15. Death rates from malignancies 166 155

16. Children in Bulgaria die more 7,8 4

17. Perinatal infant mortality rate 6 11

18. Neonatal children mortality rate 4,5 2,7

19. Probability of death up to 5 years of age (the indicator considers the probability of how many from 1,000 live-born children will die by age 5) 10,2 4,8

20. Children in Bulgaria die from:

21. Bulgaria’s population pays more and more for health

22. Public money for healthcare is getting more

23. The conclusion: We pay even more money for less health !

24. We lose more from bad health: In 2013 the death cases of people in working age (20-65 years) from the 4 classes of diseases the most frequent reason for death are 18 828, incl. : - 9 952 from circulation organs diseases ; - 6 482 from cancer diseases ; - 941 from respiratory system diseases ; - 1 453 diseases of the digestive system. In 2013 every working person has BGN 5 199 from the current volume of the GDP of the country. Unrealized benefits for the GDP for 2013 as a result of the death of these persons can be calculated to BGN 97 886 772.

25. Healthcare in Bulgaria doesn’t achieve its main objective – better health for the citizens!

26. 5 national healthcare objectives: Integrated prophylaxis, early diagnosis and effective treatment of diseases and disabilities among: 1. children from 0-1 years in order to decrease the mortality with 20% for a 10 year period (up to 6.8 in1000 live-born children in 2020); 2. children from 1-9 years in order to decrease mortality with 20% for a 10 year period (up to 0.24 in1000 in 2020); 3. teenagers and young people from 10-19 years in order to decrease mortality with 20% for a 10 year period (up to 0.32 in 1000 in 2020); 4. people in economically active groups from 20-65 years in order to increase their work abilities and to decrease mortality with 20% for a 10 year period (up to 4.19 in 1000 in 2020); 5. Old people above 65 years in order to increase with 20% the average future life duration of the people after becoming 65 years old (to 15.6 years in 2020).

27. Regrouping resources in accordance with the objectives: 1. Regrouping activities; 2. Regrouping financial resources; 3. Regrouping structures; 4. Regrouping human resources.

28. 1. Regrouping activities: Implementation of: Main/basic set of healthcare activities, directed towards prophylaxis, diagnosis and treatment of the main diseases and conditions causing death and loss of work ability; maternal and child health; Also will be regulated: Additional set of healthcare activities allowing resource planning; Emergency set of healthcare activities

29. Expanding the scope of activities, conducted in primary healthcare; Integrating activities of outpatient and emergency medical assistance and medical and social services; Increase in activities performed outside the hospital – ambulatory activities, one-day surgery, outpatient activities, home cares, medical and social cares; Creating conditions for intensification of hospital activities, supported by development of structures for long-term treatment and care.

30. 2. Regrouping financial resources by sets of healthcare activities – main and additional, emergency; by types of medical assistance – primary, outpatient, specialized outpatient, inpatient; by referral promotion, prophylaxis, screening, diagnosis and treatment; by types provided for persons and insurance payments – increase of installments for persons insured by the state, increase of collectiveness of health insurance installments, development of health insurance. on the grounds of results and quality of medical assistance.

31. Basic set - Prevention; - Diagnosis and treatment of diseases that are the most common cause of death and disability in the outpatient and hospital care; - maternal and child health Hospital Patient Emergency set Life-threatening emergency conditions Additional set Diagnosis and treatment of disease outside the scope of the basic set List of waiting people Emergency conditions Possible sources of financing State budget NHIF SOI Financing sets of healthcare activities

32. New policy on medicines Objectives: Quality, safety and efficiency of medical products; Access – providing sufficient availability and accessibility to medicines; Regional use – development and affirming pharmacy and therapeutic manuals and conducting therapy with medicines with proven efficiency; Guaranteeing sustainability and predictability of expenses on medicines.

33. Mechanisms for restriction of the unjustified increase of expenses for medicines, incl.: reimburse policy which is objectives oriented; implementation of digital platform for delivery of medicine products for hospitals; development of capacity for evaluation of health technologies; progeneric medicine policy; usage of innovative medicines after provided financial stability and predictability through needs and proven efficiency.

34. 3. Regrouping structures 3.1. Implementation of obligatory National Healthcare Card: accounting population’s needs of medical assistance by types – in accordance with age structure, illnesses, morbidity, death rates, child death rates, etc.; creating obligatory minimum and maximum requirements for territory distribution of structures for outpatient, inpatient, and emergency medical assistance, high-tech medical activities; regulating the investment possibilities and access to public resources in the healthcare system

35. When developing NHC for hospital assistance and high-tech medical activities, the model of moderate polycentrism, corresponding to the principles of regional development up to 2020 will be complied with.

36. NHC will provide: Improvement of population’s access to quality healthcare services; Optimizing the structure of hospital network; Planning of public and private investments in the healthcare system on the grounds of objective needs; Improving effectiveness of public expenses

37. Time framework: Obligatory nature of NHC through changes in the Law on Hospital Institutions – January 2015; Development of National Health Card – March 2015, including: - 28 district health cards; - Card of emergency medical assistance - Card of highly specialized medical activities; Approval of NHC by the Council of Ministers – April 2015

38. 3.2. Implementation of obligatory accreditation of hospitals through transparent and objective assessment system of:  Structure  Processes  Results on the grounds of:  improved medical standards ;  criteria and indicators for quality of medical activities;  system for evaluation of patient satisfaction.

39. 4. Regrouping human resources Planning on the grounds of the needs of medical assistance; Implementing new personnel categories for the healthcare system – doctor’s assistants, paramedics; Orienting the medical education to changing needs; Mitigating the specialization conditions for doctors and other medical specialists; Development of the system for continuing education in the healthcare system;

40. Development of new skills – conducting services in medical and social teams, new forms of servicing, encouraging empowering the patient; Implementing new model for payment of those working in the healthcare system, related to educational and qualification degree and achieved results.

41. More: Concept for development of the system for emergency medical attention – November2014 Concept for electronic healthcare – December 2014 Set of legislative changes with short-term measures for stabilizing the healthcare system – December 2014 Updating the National Healthcare Strategy and Action Plan – January 2015 Set of legislative measures with long-term measures for stabilizing the healthcare system – January 2015. New model of medical expertise – March 2015 Concept and Plan for reconstruction of the system for hospital assistance – April 2015.

42. „ The objective this is a dream which has a set term!“

43. Thank you for your attention!