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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
27 May 1990 by the 27th meeting of the Bulgarian Medical Association. And shortly before that - on 10 and 11 March 1990 the National Conference in Plovdiv adopted a resolution for restoration of the Bulgarian Dental Association.
The purpose of the present study is to analyse the occurrence, dynamics in the number and structure of the medical staff and activity of the inpatients' medical institutions (multi-profile hospitals for active treatment - MHAT) private, state and municipal property in the region of Plovdiv for the period 2010-2014 inclusive.
Materials and methods:
Subject of observation are the inpatients' medical institutions (multi-profile hospitals for active treatment) private, state and municipal property in the region of Plovdiv. The study is retrospective and covers a 5-year period (2010-2014 inclusive). The analysis was performed using qualitative and quantitative indices. The primary information has been derived from data supplied by the National Statistical Institute and the Ministry
of Health - National Centre of Public Health and Analyses, Regional Health Inspection - Plovdiv. The statistical processing of the information involved variational, alternative and non-parametric analysis. The computer processing of the collected database was carried out using statistical pack SPSS version 19 and Microsoft Excel.
Results and discussion:
The region of Plovdiv occupies 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 region of Plovdiv was 675 586 people and constitutes 9.4% of the population of the country. There is a tendency of decrease in the population in the region - from 696300 in 2010 to 675 586 in 2014.
During the analyzed period of time (2010-2014 inclusive), the number of MHAT - state and municipal property was permanent while the number of private MHAT increased, starting from 5 and reaching 10 hospital institutions (Table 1).
Table 1
Number of MHAT in the region of Plovdiv
2010 2011 2012 2013 2014
MHAT 8 8 8 8 8
Private MHAT 5 5 9 8 10
The number of beds in those institutions also varies (Chart - In the privately owned MHAT there is an upward
1): trend: from 567 in 2010 to 1721 in 2014, or almost three times
- In state and municipality owned MHAT it marks a higher. downward tendency - from 2986 in 2010 to 2908 in 2014.
Number of beds
/ A 1 1
2010year 2011year 2012year 2013year 2014year
□ MHAT 2986 2886 2875 2895 2908
□ R-ivate MHAT 567 616 1015 1192 1721
Chart 1
The bed-days have their specifications (Chart 2): - in private MHAT their number is tripled: from 120987
- in state and municipal MHAT their number is in 2010 to 371650 in 2014. decreasing: from 911 324 in 2010 to 848476 in 2014.
Bed - days
ÜL
OL
ut
ÏÏL
i
2010year 2011year 2012year 2013year 2014year
□ MHAT 911324 889369 855073 872106 848476
□ Private MHAT 120987 159317 225373 281525 371650
Average stay in days
/ A r
2010year 2011year 2012year 2013year 2014year
□ MHAT 5,2 5 4,9 4,8 4,7
□ Private MHAT 3,2 3,6 3,6 3,5 3,7
Chart 2
The average stay of one patient in days is lower in private MHAT (Chart 2).
Chart 3
The process of diagnostics and treatment in MHAT is carried out by physicians and nurses, with the help of other medical and non-medical personnel (Table 2):
- in the state and municipal MHAT the number of physicians in 2010 was 1243 and in 2014 - 1307 - marks a slight increase.
In private MHAT the number of physicians in 2010
was 221 and in 2014 is already 554 - marking a considerable increase (Chart 3).
- the number of nurses working in state and municipal MHAT decreases
- the number of nurses working in private MHAT rises by three times.
Table 2
Number of physicians working in MHAT
2010 2011 2012 2013 2014
State and municipal MHAT 1243 1252 1289 1294 1307
Private MHAT 221 266 378 422 554
Number of nurses working in MHAT
State and municipal MHAT 2225 2244 2219 2214 2214
Private MHAT 220 274 397 500 618
The number of patients examined by one phyician and one nurse is different and is higher in the private MHAT (Table 3).
Table 3
Number of patients examined by one physician
2010 2011 2012 2013 2014
State and municipal MHAT 132,8 129,4 124,8 128,1 130
Private MHAT 170,5 167,9 166,9 189,3 190,5
Number of patients examined by one nurse
State and municipal MHAT 74,2 72,2 72,5 74,9 76,7
Private MHAT 171,2 163 158,9 159,8 170,8
Conclusions:
1. Introduction of contractual relation and ensuring competitive environment among the medical service providers are important elements of the contemporary health system.
2. The opening of each private MHAT is preceded by good marketing of the needs of health services by medical specialties for the population of Bulgaria.
3. The increasing number of bed and treated patients in private MHAT is an index for increasing quality of the diagnostic and treatment process in a competitive environment.
4. The lower average stay in days of patients in private MHAT is an index for precision of the pre-stationary paraclinical preparation mostly performed in pre-hospital medical institutions.
5. The difference in the number of medical specialists working in the different MHAT informs us about the tendency of attracting and keeping cadres who apart from just remuneration, also need continuing qualification.
6. The contemporary hospital environment is an important element of the treatment process. It is an obligation of everyone - from the hospital attendant to the manager of the medical institution.
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