Management in Health, Vol 15, No 4 (2011)

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Tony J. VEKOV,, Silviya S. Aleksandrova-YANKULOVSKA, Gena G. GRANCHAROVA, Nadia R. VELEVA, Makreta T. DRAGANOVA






The aim of this paper is to explore the trends of hospitalization and to analyse the main determining factors for over-hospitalization.

Methods. The analysis is based on the Annual financial reports of the National Health Insurance Fund (NHIF) in Bulgaria, the Annuals of Public Health Statistics published by the National Centre of Health Informatics, and corresponding data for European countries the European Health for All Database for the period 2000-2009.





Conclusion. The main reasons for the enormous increase in hospital admissions have been mainly related to the increased induced demands for hospital services, ineffective referrals and treatment of chronic diseases in hospitals for acute diseases, patients’ mistrust to outpatient care, low efficiency of primary health care, inadequate supervision and regulation by the National Health Insurance Fund. Improper and ineffective health policy and hospital management led to consumerist attitudes in health care that contribute more to health care providers than to the patients in need.

Key words: over-hospitalization, induced demand, hospital services cost, hospital management.

For a period of ten years, the expenditures for hospital services have increased by 390% while the GDP has grown in real terms only by 47%. The number of hospital admissions since 2004 to 2009 has increased more than twice (from 738 978 to 1 769 230). The critical point of increase was observed between 2005 and 2006 when all the financing of hospital services was totally undertaken by the NHIF.
Changing the management and financing in Bulgarian health care system after 2000 led to many new problems in organization and management of medical activities, especially in hospital care, after the adoption of the Health Care Establishments Act in 1999. Serious problems in hospital care occurred in relation to the induced demands for hospital services which contribute to over-hospitalization and overexpenditures.

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