The health care system in the Smolyan district consists of:
1. Primary health care institutions – individual and group primary medical and dental care practices ;
2. Medical establishments for specialized medical and dental care – individual and group practices, medical centers, diagnostic and consulting centers;
3. Hospitals – 4 hospitals for active treatment, 3 specialized hospitals for rehabilitation and а Center for Mental Health;
4. Emergency Medical Assistance – Emergency Medical Center
with 9 branches for emergency medical care and Emergency Department of “Dr Bratan Shukerov” Hospital
5. Emergency medical care, implemented by Smolyan Diagnostic consultative Center , “MBAL-Devin” EAD and individual practices for primary care
The population in Smolyan District amounts to 105 421 persons or around 1,5% of the total population of Bulgaria (31/12/2018). The demographic trends are extremely negative and are connected with the decrease and aging of the population, accompanied by very low birth rates and increased mortality.
The population in Smolyan Region is decreased with 19 374 persons (or 15,5%) for the period 2008-2018, while the average rate for the country is 7.45%
Emergency Medical Care
On the territory of Smolyan Region there are 71 outpatient care establishments for primary medical care, from which 65 have signed contracts with Bulgarian National Health Insurance Fund (BNHIF) (31/12/2018).
In many of the small villages, especially the ones located in remote areas, doctors are unwilling to work and do not register medical practices. The health care services in these settlements are provided by medical specialists from the individual healthcare practices with signed contracts with BNHIF.
One outpatient care establishment for primary medical care is responsible for 1485 patients, with a tendency for incensement of this number.
Primary Dental Care
The Individual practices for primary dental care are 120, while the registered group practices for dental care are 6 (31/12/2018). 99 of all practices for dental are situated in the cities of the region, while 57 are located in the Smolyan City.
The total number of dentists is 128.
Large number of the dentists have registered second practices in more remote areas of the area.
1 medical specialist in the field of dental care is responsible for 831 patients.
Conclusions
• There are no group practices registered for both primary medical and dental care.
• Large number of acting doctors are in retirement age.
• Better provision of the population with dentists in comparison with other medical specialists.
Specialized outpatient care medical healthcare
In 2018, the specialized outpatient medical healthcare in Smolyan region is provided through:
• 12 medical centers, located in municipalities Smolyan, Madan, Zlatograd, Rudozem, Devin, and in Pamporovo.
• 1 diagnostic and consulting center , located in Smolyan;
• 63 Individual practices for primary care
• 4 group practices for specialized health care
• Most of the medical staff working in specialized outpatient care establishments is also involved in and responsible for hospital care, which leads to the provision of specialized medical assistance in out-of-hospital conditions.
Specialized outpatient dental healthcare
There are no specialized dental care establishments in Smolyan region, although there is medical staff with specialty in Surgical Dentistry, Therapeutic Dentistry, Orthodontics, Prosthetic Dentistry, Pediatric Dentistry and others.
In the region there are operating hospitals for primary dental care, in which specialized dental services are provided as well.
The population is looking for specialists outside of the area.
Hospital healthcare
In 2018, in Smolyan region are operating:
• 4 hospitals for active treatment in Smolyan, Madan and Zlatograd
• 3 specialized hospitals for rehabilitation in Banite, Rudozem and Devin
• Center for Mental Health in Smolyan
The distribution by type of hospital beds is as follows:
• For reanimation and active treatment – provision 0,7 per 10 000 inhabitants;
• For active treatment – 509 beds
• For long-term treatment – 41 beds
• For physical and rehabilitation medicine – 437 beds
• Psychiatric – 40 beds.
In 2018, in the healthcare establishments have been staffed with:
• 197 Doctors – 170 on employment contract,
• 5 Pharmacists – all on employment contract,
• 388 Medical staff with special medical education / nurses, midwives, paramedics, technicians, etc.) – 354 on employment contract,
• 355 Other staff – 326 on employment contract.
The incidence of hospitalizations / admitted patients for treatment of class I to XXI / on 10,000 of the average annual population is 3657,5 0/000.
Turnover of hospital beds is 38.
The average stay of a 1 patient being treated is 5.9 days.
The use of hospital beds in days is 227 days.
Hospital lethality is low.
Number of hospitalizations / admitted patients for treatment of class I to XXI for the period 2004-2018
Conclusions:
1. The medical institutions for hospital care in the Smolyan region are challenged by the lack of working structures for long-term treatment, treatment of cancer patients and for palliative medical care;
2. Specialized hospitals for rehabilitation have a leading place in the field of rehabilitation aid, not only in Smolyan region, but also on a country level.
3. Insufficient number of the medical specialists including anesthesiologists, pediatricians, neonatologists, radiologists, psychiatrists, pathologists, forensic surgeons, microbiologists, virologists and many others;
4. Large number of medical specialists work in two types of medical establishments – hospital and outpatient;
5. Hospitals are challenged by the difficulty to meet with the established criteria and requirements of medical standards for number of doctors and a number of specialists, including those certified for high-tech research.
Emergency medical care
The emergency medical care is provided by the Center for emergency care – Smolyan, which has 9 branches for emergency medical care, located in the municipal centers, except Municipality of Borino, which is covered by the branch in Devin.
In 2018, 23399 emergency calls were received, from which 79.6% for emergency medical aid (18549 calls) and 10.5% for urgent medical assistance (2451 calls), 9.9% for sanitary transport (2310 calls) and 0.5% false calls.
Patients who received medical assistance are 20888, including: children – 2037, with a disease – 17,976, with injuries – 2750 persons and with poisoning – 123 persons.
Emergency room
• In Smolyan region, there is one Emergency Room Department, which is operating in “Dr Bratan Shukerov” Hospital, Smolyan. In the hospitals in municipalities of Devin, Madan and Zlatograd only consultative assistance.
• In the Emergency Department, 12399 outpatient examinations were performed to assess the state of health and to provide emergency services.
• Hospitalized were 5530 patients (44.6%), 7445 patients (60.05%) needed emergency medical care, 4954 patients (39.95%) needed urgent medical care.
Urgent Healthcare Services
In 2011, the Diagnostic and consulting center, located in Smolyan, has opened a structure for urgent medical care. 2629 examinations have been made.
In 2017, the Hospital in Devin has opened a duty cabinet. It carried out 1548 examinations of emergency patients.
Main problems and challenges
• The established healthcare network is characterized with uneven territorial disposition of primary medical healthcare and specialized practices.
• There is a concentration of specialized medical care in the town of Smolyan and 3 municipal centers, which causes limited access of the population to medical care.
• There is also a disparity between the population of the municipalities in the area of access to hospital medical care due to the limited capacities of the municipal hospitals.
• In the field of outpatient healthcare, the patients suffers from restricted access to choice of General Practitioner (GP) as well as access to already appointed GP. In the individual practices with registered large number of patients, the GP struggle to provide care to all of their patients.
• There is a tendency to exclude the persons without health insurance from the general practitioners’ list of patients.
• Patients suffers from limited access to medical services provided by appointed GPs at night and during weekends.
• In the outpatient healthcare system, the individual form of work organization continues to dominate.
• The problem with not enough health preventionis is still existing.
• Shortage of medial specialists. The number of doctors per population is lower that the average rate for the country, which creates difficult access to medical care services.
• There is significant shortage in specialists in psychiatry, infectious diseases, pediatrics, emergency medicine, microbiology, urology, clinical laboratory, physical and rehabilitation medicine and a number of others. Completely lack of specialists in oncology, virology, toxicology and those with close surgical and pediatric specialties.
• The lack of health care professionals creates change in ratio nurses / doctors.
• In addition, the average age of medical staff is higher compared to the average for the country. Common practice is, doctors in retirement age to work in hospitals.
Possible solutions to the identified problems
1. Applying new approach in human resource planning in the healthcare system as a whole. This includes involvement of institutions and business for provision of encourage medical staff to engage in specializations and remain in the hospital their study.
2. Increased financing for the healthcare system on an yearly base (not only as a percentage of GDP, but also as the amount of the health insurance contribution).
3. Demonstration of prevention and health promotion as the leading national priority. Particular attention should be paid to socially significant diseases as well as pregnant women and children.
4. Identifying the health problems of adolescents (up to 18 years of age) as a national health priority with guaranteed public and public commitment to their prophylactic, diagnostic, curative and rehabilitative services.
5. Attracting new sources of funding for investments in the new, modern diagnostic and healing equipment, including thorough European Structural Funds.
Regional Health Priorities
1. Addressing imbalances in the regional health system through restructuring and effective management of hospital care, implementing, coordinating and controlling the implementation of national and regional programs, as well as improving the interaction between the healthcare structures in the area.
2. Clear human resource planning and forecasting in the field of healthcare system.
3. Creation of conditions for expanding the participation of non-governmental organizations in the activities related to the implementation of the health policy.
4. Investments in eHealth and development of an integrated information system.
5. A new approach in the healthcare system control based on electronic management of medical activities and analysis of the performed medical services on the basis of strict standards and criteria for quality assessment of the provided services.
6. Improving the health status of the population by provision of high quality medical services.
Used sources of information:
– Documentary and mathematical-statistical methods from routine statistical reporting;
– A conditional comparison with the country average indicators by type of medical establishments;
– Data from the last completed reporting campaign – 2018.
This document is created under the project “Improving healthcare access through a personal monitoring system“/eHealth monitoring/, Subsidy contract B2.9a.11 with the financial support of Cooperation Programme “Interreg V-A Greece-Bulgaria” 2014-2020, Co-funded by the European Regional Development Fund and National funds of Greece and Bulgaria. The entire responsibility for the contents of the document rests Euroradar Association and under no circumstances it can be assumed that the materials and information on the document reflects the official view European Union and the Managing Authority