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6professional activity, career development and partnership between colleagues. A skilled manager is the one who protects the interests of his staff.
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2. Stambolova. // Zdravni grizhi, 7, 2009, N 4, ISSN 1312-2592, a 14-19
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4. Chaneva, G. Professional competence of nurses - a guarantee for promotion of the profession in modern health care Zdravni grizhi, 13, 2015, N 1, ISSN 1312-2592, a 5-10
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7. Doinovska, R. Health care professional's attitude towards professional and career development. Zdravni grizhi, 9, 2011, N 2, ISSN 1312-2592, c 16-23
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DEMOGRAPHY, BIRTH RATE AND ABORTIONS IN THE DISTRICT OF PLOVDIV
Shopov Dimitar Georgiev
MD, PhD, Chief Assistant Prof. Department of Social Medicine and Public Health Medical University - Plovdiv, Bulgaria Mihaylova Vanina Krasteva PhD, Assoc. Prof. Department of Preventive Medicine, Faculty of Public Health, Sofia; Chief Assistant Department of Healthcare Management, Faculty of Public Health, Medical University, Plovdiv, Bulgaria
Stoeva Teodora Radeva Senior health care University Hospital "Sv. George" - Plovdiv Bulgaria
ABSTRACT
The macroeconomics, the labour market and the standard of life of the population play a decisive role for the demographic processes in Bulgaria. The inflation and the inherent financial destabilization suppress the reproductive attitude of the population. The present article analyzes:
the tendencies of the geographic indices of the population in the district of Plovdiv birth rate
the dynamics of the registered abortions: by age, by type, at will for a 5-year period from 2010 to 2014 inclusive. The following facts have been established:
- The population in the distirct of Plovdiv decreases
The highest number of abortions is performed by women in the age group 20-29, immediately followed by those aged 30-39.
- A high relative share of the spontaneous abortions towards the total number of abortions
- A high relative share (49.7%) of desired abortions, performed by women who do not have children or have only 1 child. The possible reasons for the mass practice of abortion as a means of birth rate control are indicated.
Key words: abortion, natural growth in population, demographic indices, population, birth rate, fertile age
Introduction: issue concerning all European countries. According to a
Reports and analyses of world and European official study of the UN, the population of our continent is drastically institutions point out that the demographic problem is an decreasing and the tendencies are for deepening of the crisis.
Bulgaria occupies 210th place according to birth rate in the world, with 8.92 births per 1000 people, states a report of the World Book of Facts as of March 2014. Our neighbouring countries are ahead of us: Macedonia - 171th place, Romania
- 206th place and Serbia - 208th place. After us is only Greece, occupying 213th place. By death rate index, Bulgaria occupies the sixth place in the world. Here the death rate is 14.3 per 1000 people. Ahead of us are South Africa - 17.49, Ukraine
- 15.72, Lesoto - 14.91, Chad - 14.56 and Guinea Bissau -14.54. Our country occupies 229th place according to growth in the population, with a negative coefficient of minus 0.83%. The macroeconomics, the labour market and the standard of life of the population play a decisive role for the demographic processes in Bulgaria. [1;3] Our country occupies one of the last places in Europe by the index „gross domestic product per capita"[7;9]. The highest relative share in the category of poor people is occupied by people with primary and lower education, unemployed, unmarried mothers, where the level of poverty is almost three times higher than the average for the country. Poverty is also widespread in families with children, especially with three and more children[11;12]. Inflation and the inherent financial destabilization suppress the reproductive attitudes of the population and motivate many young and educated people to look for their career development abroad. Despite the decreasing rate of unemployment and the tendency of opening more workplaces, the young people are still facing difficulties in finding their first job after graduation[14;15]. There is still a controversy on the labour market - the preference for hiring young people and the simultaneous requirement for professional experience[16]. Such requirements disbalance the labour market and strain the relations between the generation.
Chart 1
The per cent ratio between men and women is in favour of the women, and in the analyzed period of time a progressive tendency in the direction of the female gender has been
On the background of the European standards, the Bulgarian population demonstrates lower sexual and contracepive culture related to the use of low-efficient traditional contraceptive methods and mass practicing of abortion[17;19].
The objectives of our study are:
- the tendencies of the demographic indices of the population in the district of Plovdiv
- birth rate
dynamics of the registered abortions: by age, by type,
by desire
Material and method:
Subject of observation is the population of the district of Plovdiv. The study is retrospective, for a 5-year period (20102014 inclusive). Quantitative and qualitative indices have been used for the analysis. The primary information has been derived from the National Statistical Institute, the Ministry of Health, the Regional Health Institute - Plovdiv. The information has been processed using variational, alternative and non-parametric analysis. For the computer processing of the collected database the statistical pack SPSS version 19 and Microsoft Excel have been used.
Results and discussions:
The district of Plovdiv is located in the central part of Southern Bulgaria and occupies an area of 5972.9 sq.m., which is equal to 5.4% of the territory of the Republic of Bulgaria.
As of 31 December 2014, the population of the district of Plovdiv was 675 586 people and constituted 9.4% of the population of the country. There is a tendency of decreasing the population in the district - from 696300 in 2010 to 675 586 in 2014. (Chart 1)
observed. The collapse of the birth rate is a consequence of the sharp decrease in the number of women in reproductive age (15-49). (Table 1)
Table 1
2010 year 2011 year 2012 year 2013 year 2014 year
Total men 48,10% 48,20% 48,20% 48,20% 47,90%
Total women 51,90% 51,80% 51,80% 51,80% 52,10%
Women aged 15-49 45,90% 44,20% 43,80% 43,50% 43,30%
Population in the district of Plovdiv
l 2010year I 2011year 1 2012year 1 2013year I 2014year
□ Total men 334955 328759 327534 327127 325608
□ Total w omen 361345 352125 351326 351070 349978
□ Women aged 15-49 166002 155945 154149 152587 151596
-rn-
increasing death rate
negative natural growth in population
Natural growth in population
11
1J
2010year 2011year 2012year 2013year 2014year
□ Birth rate 10,3 10 9,8 9,6 9,8
□ Death rate 13,9 13,8 14,3 13,6 14,1
□ Natural growth -3,6 -3,8 -4,5 -4,1 -4,3
The natural growth in population in the district of Plovdiv (Chart 2) is in the direction of depopulation: - decreasing birth rate
Chart 2
Despite the unfavourable statistics, traditionally the birth rate in Sofia is the highest. The second place is occupied by the district of Plovdiv, followed by the district of Varna.
The ratio between the number of births and abortions per 1000 women in the district of Plovdiv is 1:0.4, which has not changed for the last ten years (Chart 3). The change in the model of cohabitation of young couples, most of which live together
Chart 3
The facts with respect to the registered abortions in the age group 20-29, immediately followed by the age group 30-39 have
without marriage, also plays an important role for the number of newborns. In the past one of the main reasons for concluding a marriage was unplanned pregnancy. Living together without marriage and the spreading of the methods of contraception even among the Roma population gives an opportunity for the couples to postpone the birth of their children for better times.
been analyzed and graphically presented. This is an alarming fact, as those age groups have the highest fertility rate.
Births and in the district of Plovdiv
lilfililhlh.
2010year 2011year 2012year 2013year 2014year
□ Births 43,8 44,5 45,4 44,4 46,7
□ Abortions 16,4 17,4 16,5 16,9 17
Registered abortions
CD
an
below 20years 20-29years 30-39years over 40years
□ 2012year 9,10% 43,30% 42,40% 5,20%
□ 2013year 10,30% 43,60% 39,90% 6,20%
□ 2014year 9,70% 43,60% 41% 5,80%
Chart 4
The registered abortions by type have their dynamics during the observed period of time (Chart 5). The highest relative share in the regressive tendency is occupied by the spontaneous abortions. They are followed by the desired abortions. They mark a progressive tendency. The abortions by medical indications have a modest share (around 6%). The economic realities and the changing role of the women in the
Chart 5
The fact reported from the data on chart 6 for the distribution of desired abortions is also alarming. The highest per cent belongs to the mothers with two children, followed by mothers with one or without children, considering the fact
Bulgarian society do not allow for the reversion to the model of simple reproduction, where the generations are replaced by the same number, without increasing the population. To this end a woman must have at least two children in her fertile age - between 15 and 49. Statistics shows that this number is below 1.5 on average and marks a downward trend on the background of the reducing number of women in reproductive age.
that from all desired abortions in the district of Plovdiv in 2014, 49.7% have been performed by women who do not have children or have only 1 child (Chart 6).
Registered abortions by type
— |—i i—| i—|
2010year 2011year 2012year 2013year 2014year
□ Desired 40,60% 49,10% 39,90% 41,30% 42,20%
□ Under medical 6% 7% 5,60% 5,80% 5,80%
indications
□ Spontaneous 53,40% 43,90% 53,40% 52,90% 52%
Al
ocation of willful abortions
пъ
withoutchild ren with 1child with 2children w ith3andmo rechildren
□ 2012year 23,40% 29,60% 35% 12%
□ 2013year 19% 30,70% 36,20% 14,10%
□ 2014year 21,20% 28,50% 36% 14,30%
Chart 6
Conclusions:
1. The number of the population in the district of Plovdiv decreases.
2. The analysis of the two events - childbirth and abortions in the district of Plovdiv reports a ratio of 1:0.4 between them, which has remained unchanged for the last five years.
3. The registered abortions in 2014 are 2 580 or 17.0 per 1000 women in reproductive age (15-49 years of age). The number of abortions of 1000 women in fertile age in the district of Plovdiv is equal to the average rate for Bulgaria in 2014 -17.6%о.
4. The highest number of abortions has been performed by women aged 20-29, followed by those aged 30-39.
5. A high relative share of the spontaneous abortions towards all abortions
6. A high relative share (49.7%) of desired abortions performed by women who have no children or have only 1 child.
7. The probable reasons for the mass abortions as a means of control of the birth rate can be explained with the following:
- insufficient sexual education of juveniles, necessary for the formation of healthy habits, communicational skills and responsible behaviour.
decrease in the age of starting sexual life
- increase in the number of sexual partners
- promiscuous sexual contacts and lack of knowledge of preservation of the reproductive health
- insufficient family planning in practice.
Библиография:
1. Bozhikov, G. et al. Observation of abortions dynamics in the Plovdiv region for the period 1985-/ G. Bozhikov, I. Levenova, G. Ilieva, M. Bozhilova, P. Vasileva. // Sots. med., 17, 2009, N 4, ISSN 1310-1757, с. 16-17
2. Cavazos-Rehg, P.A., Krauss, M.J., Spitznagel, E.L., Iguchi, M., Schootman, M., Cottler, L., Grucza, R.A., (...), Bierut, L.J.Associations between sexuality education in schools and adolescent birthrates: A state-level longitudinal model (2012) Archives of Pediatrics and Adolescent Medicine, 166 (2), pp. 134-140
3. Chalacova, D. et al Births and abortions in Bulgaria and Europe during the second half of the 20-th century / D. Chalacova, L. Yadkova, E. Tasheva. // Sots. med, 3, 1995, N 4, ISSN 1310-1757, c 35-38
4. Chevrette, M., Abenhaim, H.A. Do State-Based Policies Have an Impact on Teen Birth Rates and Teen Abortion Rates in the United States? Journal of Pediatric and Adolescent Gynecology.Volume 28, Issue 5, 2015, Pages 354-361
5. Gohmann, S.F., Ohsfeldt, R.L.Effects of price and availability on abortion demand.
(1993) Contemporary policy issues, 11 (4), pp. 42-55.
6. Greenberger, M.D., Connor, K.Parental notice and consent for abortion: Out of step with family law principles and policies (1991) Family Planning Perspectives, 23 (1), pp. 31-35
7. Ivanov, St. et al Induced abortions in Bulgaria and the struggle against them/ St. Ivanov, D. Vassilev, T. Chernev. // Akush. i ginekol, 32, 1993, N 2, ISSN 0324-0959, c 47-48
8. Lindberg, L.D., Maddow-Zimet, I.Consequences of sex education on teen and young adult sexual behaviors and outcomes (2012) Journal of Adolescent Health, 51 (4), pp. 332338.
9. Marinova, J»The epidemy» of abortion in Bulgaria -recent status at the end of the century. Sots. med., 9, 2001, N 2, ISSN 1310-1757, c. 20-22
10. Marinova, J. et al Women's assessment about their decision on abortion: results from an empirical study / J. Marinova, St. Markova, K. Peeva. // Bulg. meditsina, 7, 1999, N 1-2, ISSN 0861-9883, c. 56-58
11. Marinova, J. Ethical aspects on abortion - debate in modern society. Bulg. meditsina, 7, 1999, N 5-6, ISSN 08619883, c. 76-80
12. Marinova, Y. et al. Characteristics of registered abortions in health services of the region of Stara Zagira for the period 1985-1994 / Y. Marinova, S. Markova, K. Peeva. // Sots. med., 3, 1995, N 3, ISSN 1310-1757, c. 26-29
13. Penman-Aguilar, A., Carter, M., Christine Snead, M., Kourtis, A.P.Socioeconomic disadvantage as a social determinant of teen childbearing in the U.S. (2013) Public Health Reports, 128 (SUPPL. 1), pp. 5-22.
14. Petrov, P. et al. Moral, ethical and clinical aspects of abortion / P. Petrov, E. Karaslavova, D. Markova, P. Trendafilova, T. Zlatanova. // Obshta med., 10, 2008, N 3, ISSN 1311-1817, c.
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48-52
15. Popova, T. et al. Voluntary abortions - topical issues in health education of young people / T. Popova, K. Atanasova. // Sestr. delo. MP, 39, 2007, N 3, ISSN 1310-7496, c. 15-21
16. Roussewa, R. et al. Induced abortion. The decision is individual, the responsibility is social
/ R. Roussewa, T. Chernev. // Akush. i ginekol. MP, 31, 2000, N 1, ISSN 0204-0956, c. 9-14
17. Russeva, R. et al. First trimester abortion. Incidence and causes. Pre- and post abortion councelling/ R. Russeva, T.
Chernev. // Akush. i ginekol., 39, 2000, N 1, ISSN 0324-0959, c. 56-58
18. Smid, M., Martins, S., Whitaker, A.K., Gilliam, M.Correlates of pregnancy before age 15 compared with pregnancy between the ages of 15 and 19 in the United States (2014) Obstetrics and Gynecology, 123 (3), pp. 578-583
19. Taneva, D. Undesired pregnancy and desired abortion. Zdrav. politika i menidzhm., 9, 2009, N 1, ISSN 1313-4981, c. 45-48
PRIVATE MULTI-PROFILE HOSPITALS FOR ACTIVE TREATMENT - MEDICAL ACTIVITY IN A COMPETITIVE ENVIRONMENT
Shopov Dimitar Georgiev
MD, PhD, Chief Assistant Prof. Department of Social Medicine and Public Health Medical University - Plovdiv, Bulgaria
ABSTRACT
Public health is a complex system including activities related to management, funding and provision of health services, improvement of the health status of the population in the country. The medical institutions on the market of hospital medical services in Bulgaria are mostly state, municipal and private business companies. The purpose of the present study is to analyse the occurrence, dynamics in the number and structure of the medical personnel and the activity of the hospitals (multi-profile hospitals for active treatment - MHAT) - state, municipal and private property in the region of Plovdiv for the period 2010-2014 inclusive. Quantitative and qualitative indices have been used. The following fact have been established:
increasing number of beds and patients who have undergone treatment in private MHAT as an index of increased quality of the diagnostic treatment process in a competitive environment.
Shorter average stay in days of patients in the private MHAT as an index and for precision of the pre-hospital paraclinical preparation, carried out mostly in the outpatients' medical establishments.
The difference in the number of working medical specialists in the different MHAT is an expression of a policy of attracting and keeping cadres who need just payment, together with continuing qualification.
Key words: public health, property, MHAT, activity, quality, patients
Introduction
Public health is a complex system including activities related to management, funding and provision of health services for improvement of the health status of the population in the country. [1;3;13] According to the World Health Organization (WHO), a well-functioning health system requires a solid mechanism of funding, well educated and adequately paid workforce, decisions and policies based on reliable information on the condition of the health system and well-maintained health establishments and logistics, in order to procure high-quality medicines and technologies. .[4;5;15;16]
The contemporary health system is based on the principles of solidarity, the right of choice and efficiency of resources. In the past decade the European health systems have faced increasing common challenges[7;8;12;14]::
- increasing costs for public health;
- aging of the population, combined with increase in the chronic diseases;
- insufficiency and unequal distribution of medical specialists.
The role of the country in healthcare is still leading in most countries although the world tendencies are towards liberalization of the market of health services and introduction of competition.[6;9]
In order to respond adequately to the new conditions and requirements of the market economy, in 1998 the National Assembly of the Republic of Bulgaria enacted the Health
Insurance Act (HIA), completely changing the principles of our health system. Introduction of the contractual relatiions, ensuring of competitive environment among the medical service providers are important elements of the contemporary health system, having the task to respond adequately to the needs of the population.
The first step in the limitation of the state monopolism on the health system is the statutory restoration and regulation of the private sector in the health system.
Initially this was achieved through the amendment and supplement of the Health Act voted by the Parliament and the statutory acts adopted by the Council of Ministers, restoring the right of private medical activity. The health network, treatment and prophylactic, as state property funded and managed by the state, remains untouched but along with it there is an actual opportunity for development of private medical institutions.
In 1995 the Parliament voted a law on the medicines and pharmacies for human medicine whereby almost the entire system of supply with medicines, with certain restrictions, is transferred to the private sector. The law has been amended and supplemented many times in the subsequent years from the point of view of the reform in the health system, in order to develop and support the process of demonopolization of the health system. Along with the changes in the legislation, a significant importance for demonopolization of the health system has the restoration of the industrial organizations in healthcare. The organization of physicians was restored on
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