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On the inequitable impact of universal health insurance: The experience of Bulgaria in transition
Stephanie D. Short
School of Public Health, Griffith University, Meadowbrook, Queensland
Valentin Dimitrov Hadjiev
School of Public Health
Griffith University, Australia
Zdravka Dimitrova Toneva
Institute of Sociology
Bulgarian Academy of Sciences, Bulgaria
Abstract
This article deals with the social democratic aspiration of equitable access to health care in Bulgaria, a country in transition since 1989 from communism and a command economy to democracy and a free market. The focus is on access to health services and resources after the introduction of a universal health insurance system, with particular reference to formal and informal out-of-pocket payments for health care. The paper reports empirical results from a national household expenditure survey, supplemented with a semi-structured interview, conducted at the end of the survey period (April-May 2002). The results bring to light the groups in society who suffer most in this scenario: the poor, Roma, older persons and those living in towns and villages. The study reveals that the stated aim of the National Health Insurance Fund, to provide equitable access to health care, is a mirage rather than a reality, as the vast bulk of health care is self funded. This paper has particular significance for understanding the challenges faced by post-communist states in their attempts to achieve social democratic health care reforms.Keywords
sociology, universal health insurance, patient payments, equity, access to health care, Bulgaria
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