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9DENTAL PRACTICE IN BULGARIA WITHIN THE PERIOD OF TRANSITION TO MARKET ECONOMY
Shopov D.G.
MD, PhD, Chief Assistant Prof. Department of Social Medicine and Public Health Medical University-Plovdiv, Bulgaria
Mihaylova V.K.
PhD,Assoc.Prof. Department of Preventive Medicine, Faculty of Public Health, Sofia; Chief Assistant Prof.
Department of Healthcare Management, Faculty of Public Health, Medical University-Plovdiv, Bulgaria
Dragusheva S.S.
Assistant Prof.Department Nursing Care, Faculty of Public Health (FPH), Medical University -Plovdiv, Bulgaria
Stoev T.S.
PhD, Assoc.Prof.Department of Health management and Economy of healthcare, Faculty of Public Health,
Medical University-Plovdiv, Bulgaria Tornyova B.
Prof.Faculty of Public Health, Department of Health Care Management, Medical University Plovdiv,
Bulgaria Alakidi A.
Medical Student in sixth year, Medicine Faculty, Medical University
Sofia, Bulgaria
ABSTRACT
Despite the deep controversies in the healthcare system, preconditioned by the economic and political changes in the social environment, the dental physicians in Bulgaria sustainably take the road to re-professionalization, mainly through restoration of the autonomy of the profession. After studying their socio-professional identity, the emphasis is put on the market aspects of the professional realization.
The present article analyses the dynamics in the organization of the dental practices under the influence of the main tendencies in the socio-economic development in statistically differentiated administrative and geographic regions in the Republic of Bulgaria for a 5-year period - from 2011 to 2015 inclusive. The following facts have been established:
> The deterioration of the demographic situation in the Republic of Bulgaria in the years of transition to market economy has increased. The tendency is towards depopulation and aging of the population.
> The changes in the age structure reflect on the content of the dental aid dictated by the needs of the separate age groups.
> The socio-demographic specification of the administrative-geographic regions imposes redistribution of the dental practitioners, their bias towards populated areas with higher number and more solvent residents.
> Parallel to the increase in the number of dental physicians, the unequality of distribution of the dental practices in the administrative geographic regions is strongly expressed.
> With the establishment and expansion of the private sector, the distribution of dental physicians depends on the market mechanisms ensuring the income and profit of the practices. The larger economically attractive centres are populated by a larger number of people and the needs of dental aid rise, just as the income of the dental physicians.
Keywords: administrative geographic regions, demographic situation, dental practitioners, private sector, population, market mechanisms
Introduction:
Within the period of transition from centralized planned economy to market relations, the organization of the dental practice in Bulgaria has significantly changed under the influence of the main tendencies of the overall socio-economic development on a local, regional and global level [4 p.69; 5 p. 115].
As a result of the changed social environment, new principles and concepts of funding are introduced in the healthcare system, medical and dental care is provided to the population, the socio-professional status of the practitioners and dental practitioners has changed [6 p.218; 7 p.32].
In the course of reforms, in the past decades, the ownership of the health institutions has passed through a number of stages: from 100% state ownership, through mixed (public-state and public-private ownership), to almost 100% private ownership. With the introduction of the market mechanisms the dental physicians were faced with significant challenges: competition, free choice, market price formation[9 p.486; 11 p. 60]. With the transition to market relations in healthcare, there is also a process of change in the ownership of the base, material and technical equipment and the dental practice. The owner, who is already an entrepreneur, assumes the financial risk by
investing his capital in an economic activity and tries to increase it[12 p.116 13 p.46].
The change in the ownership of the medical institutions and their turning into full-value market subjects creates opportunities for generation of own income from medical activity[14 p.71; 16 p.47].
The changes in the political government of Bulgaria in the last few decades and the reorganizations in the economy related thereto, position the dental practice under new conditions. The state government existing prior to the beginning of the reforms (19451989) was preconditioned by the planned economic development and today each participant on the market determines and plans his development. Under the new conditions, dental services to the population are subject to new market principles. Sources of income are the health insurance contributions, household budgets, proceeds from companies and organizations[18 p.290; 20 p.19]. The transition in Bulgaria is of „Semashko" transitional type in a contractual model of social health insurance. In the countries with developed market economy the main methods of funding of healthcare are supplemented by direct payment by the patients.
Due to the specific features of their activity, the dental practices belong to the system of payment for a type of service (fee-for-service) which is most frequent in payment to private health institutions and medical practices. The proceeds come directly from the patient or the health insurance fund at certain prices for each separate type of service[26 p.62; 27 p.28].
The objective of the present article is to study the dynamics in the organization of the dental practices in
Bulgaria under the influence of the main tendencies in the social and economic development on a local and regional level.
Material and methods:
Subject of the study is the process of formation and organization of the dental practices under the influence of the factors of the market of dental services and the new social relations. The study is retrospective for a 5-year period, from 2011 to 2015 inclusive. Qualitative and quantitative indices have been used for the analysis. The primary information has been derived from the annual reports of the National Statistical Institute (NSI). Variational, alternative and non-parametric analyses have been used for the statistical processing of the collected primary information. The computer processing of the collected database has been performed using the statistical package SPSS Version 19 and Microsoft Excel.
Results and discussion:
The Republic of Bulgaria has been divided into 28 administrative areas with average density of population - 66 people per sq.km. On the basis of its analyses, EUROSTAT divides Bulgaria into administrative-geographic regions, combining several areas from the administrative division of the country - North-West, Northern Central, North-East, South-West, Southern, Southern Central. The categorization is based on the following economic indices: GDP of the region, inflation, infrastructure, transport, degree of development of education and healthcare, unemployment rate (whose levels vary for the country in general and by regions).
Table 1
Northwestern Central North North-East South-East South-West Central Southern
Vidin Veliko Tarnovo Varna Burgas Blagoevgrad Kardzhali
Vratsa Gabrovo Dobrich Sliven Kyustendil Pazardzhik
Lovech Razgrad Targovishte Stara Zagora Pernik Plovdiv
Montana Ruse Shumen Yambol Sofia Smolyan
Pleven Silistra Sofia (capital) Haskovo
For more clarity in the following diagrams we numbered the administrative-geographic regions in the following manner:
Region №
North-Western 1
Central North 2
North-East 3
South-East 4
South-West 5
Central Southern 6
Deterioration of the demographic situation in the Republic of Bulgaria in the years of transition to market economy has increased. The birth-rate decreased and the death-rate increased, the growth of population is negative, there is an intensified emmigration flow. The tendency is towards depopulation and aging of the population. The demographic structure of the population in
the administrative-geographic regions has been reflected in chart 1. During the analyzed time span (20112015 inclusive), the population decreased, the highest number being in the South-West region and the lowest - in the North-West region.
Chart 1
Number of population
nnn
ni In
2011 year
2012 year
2013 year
2014 year
2015 year
1
836601 823469 810401 797142 783909
2
853468 844511 835813 825536 815441
3
961965 957460 954536 949957 944458
4
1072850 1067981 1063690 1058515 1052575
5
2131233 2128783 2127618 2125212 2121185
6
1471107 1462348 1453619 1445836 1436216
Aging of the population can be seen in chart 2. The per cent of people over the age of 65 marks an upward
tendency, the highest being in the North-West region and the lowest - in the South-West region.
Chart 2
Per cent of the population over the age of 65
nnnnnn
2011 year
2012 year
2013 year
2014 year
2015 year
1
23,17% 23,61% 24,25% 24,81% 25,33%
2
20,75% 21,22% 21,74% 22,33% 22,87%
3
17,37% 17,74% 18,20% 18,69% 19,16%
4
18,23% 18,53%
19% 19,43% 19,86%
5
17,37% 17,61% 17,91% 18,25% 18,61%
6
18,83% 19,08% 19,42% 19,86% 20,30%
Together with the increase in the number of dental physicians, the unequal distribution of the dental practices in the administrative-geographic regions has be-
come more and more expressed. The highest rate belongs to the South-West region, followed by the South central region and the lowest rate is in the North-West region. (Chart 3)
Chart 3
Number of dental physicians
1 2 3 4 5 6
2011 year 592 605 729 786 2243 1643
2012 year 574 605 763 794 2306 1628
2013 year 609 652 805 888 2450 1809
2014 year 592 611 801 811 2453 1715
2015 year 620 655 909 885 2558 1865
The quality of dental services and the specification of the dental status depend not only on the socio-economic environment but also on the number of people treated by one dental practitioner. The higher their number is towards the total number of the population, the higher the probability for accessible and high-quality dental service. During the analyzed time span (2011-
2011 year
2012 year
2013 year
2014 year ■ 2015 year
The socio-economic status of the population is different. The average annual remuneration of the practitioners in the regions during the observed time span (2011-2015 inclusive) increases, the highest being in
2015 inclusive), the number of people treated by one dental practitioner in all regions decreased, the highest being in the North-West region, followed by the North central region and the lowest - in the South central and Southern regions.
Chart 4
the South-West region, followed by the South-East region, the lowest being in the North-West region (Table 1)
The average annual remuneration of the individuals hired on employment contracts by regions (Table 1)
Number of people treated by one dental practitioner
Number of people treated by one dental practitioner
i
1413 1435 1331 1347 1264
2
1411 1396 1282 1351 1245
3
1320 1255 1186 1186 1039
4 1365 1345 1198 1305 1189
5 950 923 868 866 829
6 895 898 804 843 770
Administrative-geographical regions 2011 2012 2013 2014 2015
North-Western 6727 7106 7449 7888 8365
Central North 6598 6990 7474 7925 8418
North-East 7350 7806 8205 8601 9234
South-East 7518 7990 8363 8900 9363
South-West 10192 10896 11583 12214 13101
Central Southern 6541 7004 7449 7954 8458
The unemployment ratio is high in the NorthWest, North central and North-East regions and the lowest in the South-West region (Table 2)
_Unemployment ratio (Table 2)
Administrative-geographical regions 2011 2012 2013 2014 2015
North-Western 12,3 14,0 14,2 12,1 10,6
Central North 14,3 15,3 13,2 10,6 9,3
North-East 18,2 16,8 12,6 10,3 9,7
South-East 11,9 13,0 11,9 10,4 7,9
South-West 8,2 9,8 8,9 6,7 5,4
Central Southern 13,8 13,5 12,0 9,2 7,1
The difficult access to healthcare and dental healthcare also comes as a result of the limited financial resources of the population, especially for the poorest circles. As a result of the reforms, there are also disproportions in the allocation of the health institutions.
Conclusion:
The recent adjustments for free treatment, the constantly decreasing standard of life are the basis of the limited opportunities for search of dental aid.
When positioning the dental activity entirely in the private sector in the newly established conditions, the modernization of the equipment and the used consumables depend on the financial abilities of the dental practitioners. Their income in Bulgaria come from the National Health Insurance Fund, other additional funds and direct payments from patients. The expenses are in different areas, for the organization of the practice - licensing, equipment of the dental office, materials, consumables, social security contributions, rent, remuneration. The dental practitioner is not only a healer but is also obliged to be familiar with the new requirements in the field of funding.
In the conditions of market economy, the admission of students is connected with the territorial needs of dental practitioners but also with the abilities for opening of dental offices from an economic point of view.
With the establishment and expansion of the private sector, the allocation of dental physicians depends on the market mechanisms for ensuring income and profit from the practices. The larger economically attractive centres are inhabited with a larger number of people and the needs of dental aid increase, just as the income of the dental practitioners.
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State Institution "Dnepropetrovsk Medical Academy of the Ministry of Health of Ukraine", Department of Obstetrics, Gynecology and Perinatology Faculty of Postgraduate Education, Associate Professor
АНОТАЦ1Я
Стаття присвячена питанням розробки математично! моделi прогнозування виникнення загрози неви-ношування ваптносп у ваптних жшок iз надмiрною вагою та ожиршням на пiдставi розширеного алгоритму дiагностики системних порушень у ще! категори ваптних жшок. На базi обстеження 175 ваптних жь нок iз рiзною масою тша (120 жшок iз надмiрною вагою та ожиршням й 55 ваптних - iз нормальною масою
