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Country/JA: Bulgaria flag Bulgaria
Action type: Program

Problem: Although there is widespread understanding of interventions that can improve the quality of cancer care, it is often challenging to shift current practice.  There is increasing interest to implement funding systems that can motivate improvement in quality of cancer care.

Objective: Medical specialists from the primary and specialized outpatient medical care can refer patients to a medical institution with a specialized structure for treatment of cancer patients. The Ministry of Health has defined a cancer care activities package that is paid for the health-insured individuals by the National Health Insurance Fund (NHIF). It identifies the features and criteria which should be followed, the approach for diagnosis and treatment procedures as well as reimbursement methods.

Implementation status: Ongoing funding program

Key Contextual Factors

  • There is a contract on a consensus basis (the National Framework Agreement – updated every year)  between the NHIF and the professional organization of doctors and dentists, which marks the rights and obligations of the NHIF, the Bulgarian Medical Association, the Bulgarian Dentists Association, the regional HIFs, and the outpatient medical care providers. 
  • All medical facilities (public and private) receive funds from the NHIF for medical drugs and services; however, there are also additional payments, paid by the patients themselves.
  • In charge of the development of clinical pathways, a group of experts together with the Bulgarian Medical Association make proposals to the NHIF. 
  • During the whole process of implementation of clinical pathways, control bodies, such as the Regional Health Inspectorates and the Regional Health Insurance Fund, execute periodical controls regarding the standards’ compliance (reflecting the clinical pathways).

Key Components/Steps

  • The cancer care activities package includes the whole spectrum of cancer control activities (including after-care and palliative care, but may exclude some drugs or symptomatic treatment)..
  • The cancer clinical pathways are tumor-specific.
  • After, the initial diagnosis, for every patient, an individualized diagnosis and treatment plan is decided, in which medical activities and drugs are included.
  • Patients have free choice to decide where to be treated.
  • If a patient needs a medical service (e.g. radiotherapy) that cannot be provided in one medical facility, s/he can go to another facility that has a contract with the original medical facility.
  • There is strict monitoring based on official reports, provided by every medical facility, and monitoring of the management of the prices stated in the pathway and the payment of all healthcare specialists (including doctors, nurses, etc.).
  • The results are reported and entail recommendations for the director of the hospital.

Main Impacts / Added Value

  • If a patient has highly specialized needs, s/he can be referred to another more specialized hospital on the basis of agreement for specific activities (supported and financed by the NHIF).

Lessons Learned

  • Clinical pathways need to assign specific percentages or remuneration amounts for the performance of different types of healthcare specialist.
  • Based on preliminary contractual relationships, one medical facility can transfer a patient to another facility in case the original one cannot provide an oncological medical service that a patient needs.
  • Specialized oncological clinical pathways for complex treatment are needed.

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Contact

  • Institution/organization: Specialized Hospital for Active Treatment of Oncological Diseases - Sofia region
  • Department/lead: Dr Diana Yordanova
  • E-mail: di.jordan@abv.bg