Bulgaristan'da Birinci Basamak Sağlık Hizmetlerinde Reformlar - Geçmiş, Bugün, Gelecek

Herhangi bir milletin ve özellikle Bulgar milletinin sağlığı, ülkenin ekonomisi, güvenliği ve kalkınması için son derece önemlidir. Diğer Avrupa ülkelerinin aksine, yapı ve işleyişteki kusurlar nedeniyle, Bulgar sağlık sistemi, halk sağlığının bir dizi önemli yönünde tatmin edici nihai sonuçlara ulaşamadı. Temel sorunların bir kısmı yüksek hastalık ve ölüm oranlarını, sağlık risk faktörlerinin yaygın bir şekilde yayılmasını ve diğer tarafta tıp uzmanlarının (doktorlar, hemşireler, destek personeli) ve hastaların yetersiz memnuniyetini içerir. Bu, Bulgaristan'ın siyasi idaresindeki değişikliklerle birleştiğinde, sağlık sisteminde radikal bir reform kararı alınmasına yol açtı. Şartlı olarak, değişiklikler doğalarına göre 6 büyük gruba ayrılabilir: 1) Sistemin demokratikleşmesine yol açan reformlar; 2) Liberalleşmeye ilişkin reformlar; 3) Birinci basamak uygulamalarının durumundaki reformlar; 4) Sistemin organizasyonu, inşası ve yapısındaki reformlar; 5) Finansman ve ödeme yöntemlerinde reformlar; 6) Birinci basamak sisteminin yönetimi ve uygulamalarında reformlar. Bu gözden geçirme makalesinin amacı, birinci basamak ve mevcut duruma odaklanarak Bulgaristan'da geçmişte gerçekleştirilen sağlık sistemi reformunun teorik çerçevesini, temellerini ve hedeflerini sunmaktır. Herhangi bir milletin ve özellikle Bulgar milletinin sağlığı, ülkenin ekonomisi, güvenliği ve kalkınması için son derece önemlidir. Diğer Avrupa ülkelerinin aksine, yapı ve işleyişteki kusurlar nedeniyle, Bulgar sağlık sistemi, halk sağlığının bir dizi önemli yönünde tatmin edici nihai sonuçlara ulaşamadı. Temel sorunların bir kısmı yüksek hastalık ve ölüm oranlarını, sağlık risk faktörlerinin yaygın bir şekilde yayılmasını ve diğer tarafta tıp uzmanlarının (doktorlar, hemşireler, destek personeli) ve hastaların yetersiz memnuniyetini içerir. Bu, Bulgaristan'ın siyasi idaresindeki değişikliklerle birleştiğinde, sağlık sisteminde radikal bir reform kararı alınmasına yol açtı. Şartlı olarak, değişiklikler doğalarına göre 6 büyük gruba ayrılabilir: 1) Sistemin demokratikleşmesine yol açan reformlar; 2) Liberalleşmeye ilişkin reformlar; 3) Birinci basamak uygulamalarının durumundaki reformlar; 4) Sistemin organizasyonu, inşası ve yapısındaki reformlar; 5) Finansman ve ödeme yöntemlerinde reformlar; 6) Birinci basamak sisteminin yönetimi ve uygulamalarında reformlar. Bu gözden geçirme makalesinin amacı, birinci basamak ve mevcut duruma odaklanarak Bulgaristan'da geçmişte gerçekleştirilen sağlık sistemi reformunun teorik çerçevesini, temellerini ve hedeflerini sunmaktır.

Anahtar Kelimeler:

Birinci basamak, Sağlık hizmeti, Birinci basamakta reformlar

Reforms in primary health care in Bulgaria - past, present, future

The health of any nation, and the Bulgarian one in particular, is extremely important for the economy, security and development of the country. Unlike other European countries, due to defects in the structure and functioning, the Bulgarian health system could not achieve satisfactory final results in a number of important aspects of public health. One part of the essential problems includes high rates of morbidity, mortality, wide spread of health risk factors, and on the other - insufficient satisfaction of medical professionals (doctors, nurses, support staff) and patients. This, combined with the changes in the political administration of Bulgaria, led to a decision for a radical reform in the health care system. Conditionally, the changes can be divided, according to their nature, into 6 large groups: 1) Reforms leading to democratization of the system; 2) Reforms related to liberalization; 3) Reforms in the status of primary care practices; 4) Reforms in the organization, construction and structure of the system; 5) Reforms in financing and payment methods; 6) Reforms in the management of the primary care system and practices. The purpose of this review article is to present the theoretical framework, grounds and goals for the reform of the health care system in Bulgaria carried out in the past, with a focus on primary care and the current state. The health of any nation, and the Bulgarian one in particular, is extremely important for the economy, security and development of the country. Unlike other European countries, due to defects in the structure and functioning, the Bulgarian health system could not achieve satisfactory final results in a number of important aspects of public health. One part of the essential problems includes high rates of morbidity, mortality, wide spread of health risk factors, and on the other - insufficient satisfaction of medical professionals (doctors, nurses, support staff) and patients. This, combined with the changes in the political administration of Bulgaria, led to a decision for a radical reform in the health care system. Conditionally, the changes can be divided, according to their nature, into 6 large groups: 1) Reforms leading to democratization of the system; 2) Reforms related to liberalization; 3) Reforms in the status of primary care practices; 4) Reforms in the organization, construction and structure of the system; 5) Reforms in financing and payment methods; 6) Reforms in the management of the primary care system and practices. The purpose of this review article is to present the theoretical framework, grounds and goals for the reform of the health care system in Bulgaria carried out in the past, with a focus on primary care and the current state.

Keywords:

Primary care, health care, reforms in primary care,

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ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez