The European Journal of Public Health Advance Access originally published online on March 19, 2009
The European Journal of Public Health 2009 19(3):326-330; doi:10.1093/eurpub/ckp027
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Your health |
Impact of health reforms on child health services in Europe: the case of Bulgaria
Boika Rechel1, Nick Spencer2, Clare Blackburn2, Richard Holland1 and Bernd Rechel3
1 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
2 School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK
3 European Centre on Health of Societies in Transition, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT UK
Correspondence: Boika Rechel, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK, tel: +44 1603 591952, fax: +44 1603 593752, e-mail: B.Rechel{at}uea.ac.uk
Received November 24, 2008 , accepted February 3, 2009
Background: In the last two decades, all countries in Europe have embarked on substantial health reforms, introducing new models of financing and provision of health services. Using Bulgaria as a case study, this article examines the impact of the reforms on child health services. Methods: This is the first of a series of papers drawing on a broader research on inequalities in access to child health services, using Bulgaria as a case study. Multiple methods and data sources were used, including a review of the literature and existing epidemiological data, 50 qualitative in-depth interviews and an analysis of regulatory documents. This article presents the findings of the documentary analysis. Results: Primary health services for children are now provided by general practitioners. Children are exempted from health insurance contributions and user fees and are formally entitled to free health care. During the first years of the reform general practitioners still had insufficient training in child health. Restrictions on the number of referrals to paediatricians and discontinuation of community services at a time when general practice was not well established, undermined access to quality care. Conclusion: While many of these issues have been subsequently addressed, the reform process was far from linear. Challenges remain in ensuring access to quality child health services to the rural population and marginalized groups, such as the Roma minority and children with disabilities. Throughout Europe, health reforms need to be based on solid evidence of what works best for improving quality of and access to child health services.
Keywords: access to care, child health services, health reform, inequalities