On July 24, 2014 the Federation of Trade Unions – Health services in the Confederation of Independent Trade Unions in Bulgaria (CITUB) held a conference on "The measures needed to improve the efficiency of the healthcare system", which aimed in a discussion with a wide range of experts to highlight existing problems and to identify the necessary measures in the field of health.

The event was opened by the President of the CITUB Plamen Dimitrov and the Vice President of CITUB and Chairman of the Federation of Trade Unions – Health services Dr. Ivan Kokalov. The conference was attended by Dr. Boyko Penkov - Deputy Minister of Health, Dr. Rumyana Todorova - Manager of the National Health Insurance Fund (NHIF), representatives of the World Health Organization of the United Nations, the Bulgarian Medical Association and the Bulgarian Dental Association, representatives the social partners, patient organizations, hospitals etc. Among the official guests of the forum was the President of the Economic and Social Council (ESC) Prof. Lalko Dulevski.

Addressing the participants, Mr. Plamen Dimitrov pointed out that the shortage of resources in the health system and is caused by the evasion of health insurance contributions. He explained that one way to provide more funds and the CITUB insisted it long time ago, is exactly the criminalization of such acts.

The analysis of the Federation of Trade Unions – Health services, presented by Dr. Strashimir Genev stated that health costs are increasing without obvious improvement in the health status of the population. In five years, the number of hospitalizations that were about 1.7 million during 2010, as well as hospital costs which were nearly 1.1 billion. lv. for 2010 grow at a very rapid pace. Highlighted was the fact that the number of hospitals increases as the total of state and municipal hospitals is 190, and the private – 108. The number of the latter is significantly increased compared to 2007, when it was only 71. In addition to the funding system, an emphasis was placed on the ever-decreasing number of qualified medical staff in urban areas, with the exception of Sofia. Although the number of physicians is above the EU average (386.3 physicians per 100 thousand inhabitants.), there are huge disparities across regions. Doctors who work in the capital are representing 28.3% or nearly one third of all physicians in the country. It is a similar situation with the health care professionals, whose number, however, is lower than the EU average. About one fifth of these professionals work in Sofia.

In his speech Professor Dulevski highlighted three main issues that need a consensus position to be formed on, namely - the balance between solidarity and justice as a fundamental principle of operation of the system, balancing public and private interests in health care, as well as searching ways of stabilization through measures to improve the financial and economic efficiency. Professor. Dulevski paid attention to the problems associated with the preparation and implementation of the young doctors in Bulgaria. He pointed out that "if no specific measures relating the proper payment of medical practice, qualification and specialization are taken after 15-20 years in Bulgaria will have good infrastructure, but there will be no specialists in the field of health". In conclusion, the President of the ESC said that by the end of the year, the Economic and Social Council will present its position on the issues and challenges facing the health sector through an opinion.

The Conference adopted a final document, which describes the necessary steps to improve the efficiency of the healthcare system. The main proposals are related to the adoption of a health strategy for the development of the system, long-term planning and taking into account the migration and the work motivation of the health professionals in Bulgaria.



is the “bridge” between citizens and the national government. Its mission is to support such “bridging” so as to facilitate the communication between the society and the national government. It is the new and modern institution of the civil dialogue.

The ESC's mission is to promote civil society organisations access to and involvement in the process of decision-making on strategic economic and social issues.

The main goal of ESC's operation is to enable different representatives of organised civil society to feel free to state their views whereas unanimity on matters of common interest is encouraged. The Council expresses and protects civil society interests by communicating agreed statements and proposals submitted by its members to the executive and legislative authorities.

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