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CONCEPTUAL MODEL FOR CAPACITY DEVELOPMENT OF
BULGARIAN HEALTHCARE
Trendafilova P. D. 1, Kehayov A. V. 2
1 PhD, Associate Professor at the Faculty of Public Health, Medical University - Sofia, Sofia, Bulgaria 2 PhD, President of South EaMern European Medical Forum (SEEMF), Sofia, Bulgaria
ABSTRACT
The purpose of this article is to develop a prognoflic conceptual model for capacity development of Bulgarian healthcare by year 2030 based on a comparative analysis, a conducted survey among healthcare managers and an expert appraisal. The expenditure per capita is an important element in building the capacity of healthcare. In 2006 public expenditure for healthcare per capita in Bulgaria amounted to 245 Levs. In 2013 the public expenditure per capita is respectively 463 Levs or there is an almofl double increase.
Keywords: capacity, conceptual model, healthcare, Bulgaria.
Introduction
The Bulgarian society and the economy in our country have to achieve some tasks in order to accomplish successful development of the healthcare syflem. Comparing to the other European countries Bulgarian healthcare is quite behind the level it should be. The prognosis about its development should take into account the level of the economic development and the conflruction of the capacity of Bulgarian healthcare. This model, relevant to the environment, shows the development of the healthcare syflem until year 2030.
Capacity building of Bulgarian healthcare is defined as a syflematic approach for continuous learning how to improve its potential, how to be used in the mofl effective way its labor,
material and financial resources in order to achieve its main objectives.
Objective
The objective of this fludy is to develop a prognoflic conceptual model for capacity development of Bulgarian healthcare by year 2030 based on a comparative analysis, a conducted survey among healthcare managers and an expert appraisal.
Methods
1. Comparative analysis.
2. Critical analysis.
3. Sociological method - a survey conducted among healthcare managers.
4. Statiflical methods.
5. Development of a prognose conceptual model for capacity development of Bulgarian healthcare by year 2030 using a modified methodology by Gladilov St. (2002). [2] Results
The expenditure per capita is an important element in building the capacity of healthcare. In 2006 public expenditure
Public expenditure for heal
for healthcare per capita in Bulgaria amounted to 245 Levs. [3, p. 20]
In 2008 the public expenditure per capita is 372 Levs and in 2013 it is respectively 463 Levs. (Table 1)
So for 7 years there is an almofl double increase in the public expenditure per capita for healthcare in Bulgaria.
Table 1.
care per capita in Bulgaria [5]
Years 2008 2009 2010 2011 2012 2013
Total expenditure for healthcare (thousands levs) 2 831 3 117,3 3 000,8 3 247,6 3 303,2 3 540,3
Population 7606 551 7 563 710 7 504 868 7 282 041 7 327 224 7 240 000
Public expenditure per capita (levs) 372 413 399 444 454 463
One of the queflions from the survey among healthcare managers was "How many levs will reach these public expenditures per capita in 5 years?" 242 managers have answered to this queflion and they indicated the mean average 972.89 levs. (Std. Dev. = 72.689; Mean=972.89; N=242) [3, p. 20]
Prognoflic public expenditure for h
We assume that this amount is achievable for the specified period. To reach it an annual flep increase is required equal to 1/5 of the difference between the proposed expenditure per capita in 2018 and those in 2013. (Table 2) 972.89 - 463 = 509.89 levs 509.89/ 5 = 101.978 levs
Table 2.
lthcare per capita in Bulgaria (in Levs)
Year 2013 2014 2015 2016 2017 2018 2019 2020 2030
Public expenditure per capita for healthcare (Levs) 463 564.98 666.96 768.94 870.91 972.89 1074.87 1176.85 2196.63
These inputs are taken into account in working out a The prognosis shows that in 2020 the public expenditure prognoflic model for capacity development of the Bulgarian for healthcare per capita would be 1176.85 levs and in 2030 healthcare for the period 2030. respectively - 2196.63 levs.
2009 2010 2011 2012 2013
Picture 1. Public health expenditure as a share of GDP [1, p. 18]
Public health expenditure as a share of GDP is about 4 percent for the lafl 13 years, with an average of 7 percent for EU countries. (Picture 1)
The model foresees a gradual increase in the share of public spending on healthcare from the flate budget and from the NHIF about 0.1 to 0.2% per annum.
The final result of this financial model is to reach the proportion of healthcare expenditures in the optimal scenario for year 2020 - 4.6% and for 2030 - 5.6%. If this happens to be achieved about this indicator Bulgaria is getting a flep closer to some EU countries.
Conclusion
The specifics of the process of capacity building of Bulgarian healthcare is expressed in the chronic insufficient financing of
the syflem. The health spendings per capita are several times lower than the lowefl in the EU countries.
The above results show that even in year 2020 and in 2030 Bulgarian healthcare will work in conditions of insufficient funding.
However, the analysis of the data obtained from the above prognoflic model shows the need for efficient use of the available resources, as well as a need for a change of the model for financing towards its liberalization.
The optimal capacity building of the Bulgarian healthcare until year 2030 should be carried out practically through an effective management carried out by competent health managers, as well as the implementation of effective prevention programs financed by the Miniflry of Health.
References:
1. Българска стопанска камара: «Здравеопазване 2014: състояние, проблеми, решения, предизвикателства». София, 2014. - 28 с.
2. Гладилов Ст., «Модели за финансиране на здравеопа-зването», Сб. резюмета, VII национална конференция на ко-легиум „Частна психиатрия". Пловдив, 28-30 юни 2007.
3. Кехайов А.В., «Стратегически приоритета за изграж-дане на капацитета на българското здравеопазване в Обеди-нена Европа», автореферат. София, 2007. - 36 с.
4. Sandier, S., V. Paris, and D. Polton., «Health Care Syflems in Transition: France. Copenhagen, Denmark: WHO Regional Office for Europe on behalf of the European Observatory on Health Syflems and Policies», 2004. http://www.euro.who.int./ document/e83126.pdf
5. World Health Organization: Global database for expenditures in health care.
ОЦЕНКА РАСПРОСТРАНЕННОСТИ ФАКТОРОВ КАРДИОВАСКУЛЯРНОГО РИСКА И САХАРНОГО ДИАБЕТА СРЕДИ ГОРОДСКОГО НАСЕЛЕНИЯ КАРАГАНДИНСКОЙ
ОБЛАСТИ
Аманжол Тогжан Толегенкызы
Студентка 7 курса факультета общей медицины, Карагандинский государственный медицинский университет,
г.Караганда
АННОТАЦИЯ
В статье рассмотрены частота отдельных факторов риска в группе высокого и очень высокого риска развития сахарного диабета у респондентов с различным кардиоваскулярным риском. Установлены значимые модифицируемые факторы риска сахарного диабета, как ожирение, нарушение гликемии натощак, артериальная гипертензия среди лиц с высоким уровнем риска кардиоваскулярных заболеваний и высоким риском сахарного диабета среди городского населения Карагандинской области.
ABSTRACT
The article describes the frequency of selected risk factors of high and very high risk of diabetes in groups with different levels of cardiovascular risk. Found significant modifiable risk factors of diabetes like obesity, impaired facing glucose, hypertension among persons with high risk of cardiovascular diseases and a high risk of diabetes mellitus among urban population of Karaganda region.
Ключевые слова: кардиоваскулярный риск, сахарный диабет 2 типа, факторы риска.
Keywords:cardiovascular risk, diabetes mellitus type 2, risk factors
Кардиоваскулярные заболевания (КВЗ) и сахарный диабет (СД) удерживает первенство среди социально значимых болезней в XXI веке, приводя к ранней инвалидиза-ции и смертности населения [7, с. 4]. Оба эти заболевания - мощные независимые факторы риска быстрого развития большого количества случаев кардиоваскулярной патологии, атеросклероза, поражений сосудов глазного дна, почек и периферических сосудов. Казахстан занимает первое место по уровню смертности от болезней системы кровообращения среди стран Европейского союза, Центральной и Восточной Европы и Центрально-Азиатского регионов [5, с.164]. Ежегодный ущерб от КВЗ в Казахстане составляет в среднем около 89 миллиардов тенге [2, с.13]. Согласно данным крупных клинических исследований имеется неразрывная связь КВЗ и СД [4, с.52]. На сегодняшний день СД 2 типа рассматривают как эквивалент присутствия у пациента клинически выраженного кардиоваскулярного заболевания. Распространенные факторы риска кардиоваскулярных заболеваний в Казахстане - это избыточный вес (55,6%), ожирение (23,7%), артериальная гипертензия (35%) и употребление табака [3]. Эксперты пришли к выводу о том, что первичная профилактика риска КВЗ и СД 2 типа может значительно снизить экономический ущерб и других последствий этих социально значимых заболеваний [1, с.7]. Так, по оценкам экспертов ВОЗ, в масштабах популяции даже
умеренное снижение уровня АД, холестерина (ХС), распространенности ожирения и курения одновременно приведет к сокращению частоты развития КВЗ в 2 раза [6, с 1132]. В этой связи главной стратегией первичной профилактики КВЗ и СД 2 типа является выявление распространенности модифицируемых факторов риска.
Цель исследования: изучение частоты модифицируемых факторов риска сахарного диабета среди лиц с высоким уровнем риска КВЗ и СД среди городского населения Карагандинской области.
Материал и методы исследования. Проведено одномоментное поперечное (кросс-секционное) исследование в виде скрининга среди населения г.Сарань, Карагандинской области. В исследование были включены 724 респондента с наличием кардиоваскулярного риска в возрасте 18-65 лет, из них мужского пола составили 20,4%, женщины 79,5%. Объем выборки определялся исходя из необходимого уровня значимости. Скрининг включал анкетирование, c применением международных опросников по установлению факторов риска социально-значимых заболеваний, как СД, КВЗ, антропометрию, измерение АД, определение глюкозы и холестерина крови. Определение глюкозы крови проводилось с помощью глюкометра Accu-Chek (RocheDiagno^ics, Германия), холестерина крови -Accutrend Plus (Roche Diagno^ics, Германия).
