SURVEY OF MEDICAL DEVICE COSTS AND PATIENT CO-PAY

Abstract

Over the last five years, there has been a persistent trend of increasing total health care costs in Bulgaria. It has been established that the ratio between public and private health care costs is steadily changing in the direction of a continuous increase in the costs of the private sector, incl. and households, at the expense of a reduction in public. The changes that have taken place in recent years in the mechanisms and especially in the financing system of the health insurance system are mainly at the expense of the increased financial participation of Bulgarian citizens. The article presents a study of the types of costs for medical devices/implants invested in medical activity in Bulgaria. Aim: to determine the trend in medical device/implant costs in health insurance settings over the past five years. Methodology: The costs of medical devices/implants during the investigated period of 2018. 2022. A statistical method was used to analyze data from the National Health Fund in Bulgaria for the period 2018 2022. Results: During the considered five year period, it was found: a decrease in the total costs of medical devices/implants. Incremental costs paid by the patient, compared to total costs and public costs of the national health fund. The rate of increase of private expenditure on medical devices from total expenditure is fifty three percent. In the last three years of the five year period, private spending exceeded public spending by over one hundred percent. A tipping point of a sharp excess of private costs paid by patients compared to public costs and total costs of medical devices/implants is the period of the Covid 19 pandemic, when an excess of one hundred percent is found. Discussion: The data from the study of costs for medical devices/implants, during the period "2018
2022", repeat the trend of distribution of health care costs among the subjects of the health insurance market from the previous period in Bulgaria. There are significant differences in the structure of healthcare costs in Bulgaria and the same in the European Union. According to the structure of healthcare costs, Bulgaria ranks first in the European Union in terms of the relative share of private (non public) costs. Private payments are nearly 45.4% of all payments, and public payments are fifty four percent, calculated according to data from the World Health Organization. In other European countries, this ratio is up to thirty percent private and over seventy public expenditures. The financial burden in Bulgaria is shifting to the area of private funds (cash payments) and not to public funds. The low share of public funds for health care as an absolute amount and as a share of total health care costs is a factor in the deterioration of the quality of medical care. Poor quality is the cause of rising production costs (of health services). Conclusion: There is a tendency for private expenditure on medical devices/implants to exceed public expenditure from the health fund and total expenditure. The private expenditure on medical devices/implants from the survey follows the trend of private expenditure in the structure of health expenditure in Bulgaria. Additional payment for medical services is a new phenomenon in the health system of Bulgaria, which is being formed and modified in the conditions of health system reform. In Bulgaria, the concept of "surcharge" is not precisely defined and regulated in law as a phenomenon in the health insurance system. There is ambiguity in the legislation of Bulgaria regarding the amount of co payment and the type of medical activities. Additional payment by health insured persons has been introduced only for some activities, but the threshold from which the patient should pay for the services has not been specified. The reason for this ambiguity can be found in the solidarity model of health insurance. a new trend in health policy is being created: co payment.