The implementation of the 11th revision of the International Classification of Diseases requires ... more The implementation of the 11th revision of the International Classification of Diseases requires a comprehensive approach, involving the adaptation of regulatory frameworks, updates to health information systems, and the allocation of necessary resources for a smooth transition. One of the key steps in this process is the precise translation and adaptation of terminology to ensure clarity and alignment with Bulgarian medical practice. This will benefit not only physicians but also health economists, programmers, and administrators working with medical data. Another major challenge is the training of medical personnel. A structured training process and practical guidelines for using the new classification must be developed. This includes both foundational knowledge and specialized courses for different groups of professionals involved in the coding process. Ensuring continuous training will help minimize errors and facilitate the transition to the new system. Beyond training, there is a need to analyze and update all medical documents that use diagnostic codes ‒ including medical records, outpatient forms, death certificates, prescriptions, and other administrative forms. Adapting these documents will prevent inconsistencies and ensure the correct application of the new codes. Despite the challenges, the implementation of the latest classification presents an opportunity for more accurate medical statistics, more efficient healthcare resource management, and better integration of Bulgaria into the global health information system. Successful adoption of the new classification will require a well-coordinated process involving all stakeholders, with a clear strategy and a long-term vision for development.
I. Анализ и оценка на гъвкавостта при криза на здравеопазването и на социалното осигуряване/ Anal... more I. Анализ и оценка на гъвкавостта при криза на здравеопазването и на социалното осигуряване/ Analysis and assessment of flexibility in the event of a health care and social security crisis .
Годишен доклад 2013 "Икономическо развитие и политика в България: оценки и очаквания. Тема на фокус: Политики в здравеопазването – икономически анализ и оценки
ABSTRACT Health services in Bulgarian hospital system are currently paid on the basis of clinical... more ABSTRACT Health services in Bulgarian hospital system are currently paid on the basis of clinical pathways (CP). Many authors consider that this method of payment is inadequate for the following reasons: - Heterogeneity of clinical conditions grouped into CPs with respect to patients’ treatment and data analysis; - Not reported concomitant diseases and complications; - Subjectivity in the development of clinical pathways and determination of their costs; - Easily manipulated costing; - Distortion of real data on morbidity; - Impossibility to estimate the real population health needs; - The key stakeholders in the delivery and receipt of health care are unsatisfied with the implementation of CP as a payment mechanism. Applying the model of clinical pathways resulted in: - Uncontrolled and increased spending in the sector; - Modified statistical data does not allow assessing health needs; - Unimproved quality of service and medical cares; - Impossibility to objectively assess activities performed; - Decreasing trust in health system. In this context, Bulgarian politicians decided to gradually shift from payment based on clinical pathways to payment based on diagnosis-related groups. This article reviews calculation stages, mathematical models and results from grouping and calculating relative value units and costs of diagnosis-related groups (DRG), providing a comparative analysis with Australian DRGs. In addition, two comparisons between clinical pathways and respective DRGs are examined to prove the assertion that DRGs allow more accurate and reliable calculation of medical activities.
Целта на настоящото изследване е на се направи оценка на дейността и съответно заплащането на кли... more Целта на настоящото изследване е на се направи оценка на дейността и съответно заплащането на клиничните пътеки, в няколко направления на болничните услуги за да се подценени/надценени като дейност и съответно кои са подценени и надценени като цени. Данните по които се работи са на базата на предложението на БЛС за цени и обеми за 2024 година разпределено по специалности. Приложен е метода на сравняване на два z-score, съответно за дейност и цена чрез графичен метод.
[Peripheral, central neurofibromatosis and multiplex meningiomas (a historical review)]
PubMed, 2002
Despite that the neurofibromatosis and the multiplex meningiomas have been known for centuries, i... more Despite that the neurofibromatosis and the multiplex meningiomas have been known for centuries, it is hardly during the last decade that a significant progress has been achieved in the understanding of their etiology and pathogenesis. The development of the concept for NF is being followed from the time of the first descriptions till today.
EPR unlimited - brief EPR overview and prognosis, Bulgarian perspective
ABSTRACT The debate over fare medicinal products pricing is one of the most contentious issues th... more ABSTRACT The debate over fare medicinal products pricing is one of the most contentious issues that emerges again within the EU countries. External price referencing (EPR) is used by many EU member states (and others) for the last years as a measure and tool to control marketed medicinal products’ prices. Authors’ strong believe is that although EPR tool embraces viable and progressive concepts is highly liberalized in its application into routine practice and hugely over utilised in Bulgaria (as well as in majority of EU member states), and that it is highly likely it will be long term ineffective. Authors briefly present the current status and ask the question “What is next?” At the end the likely future scenarios are discussed.
Situation analysis of municipal multi-profile hospitals for active treatment (MHAT). Operational problems and reasons for closure
ABSTRACT Impatient care establishments are commercial entities and as such can be the subject of ... more ABSTRACT Impatient care establishments are commercial entities and as such can be the subject of any known type of corporate assessment. On the other hand, hospitals operate in a quasi-market. This fact makes it difficult to apply “pure” assessments. An additional complication stems from the social role that the hospitals have to play. Therefore, assessments need to be interpreted in such a way so as to provide adequate managerial information. This situation analysis aims to explore the hospitals’ capacity to operate while preserving their economic stability. It will also delineate the boundaries of their sustainability.
The present article deals with the theme of efficiency in healthcare and especially technical eff... more The present article deals with the theme of efficiency in healthcare and especially technical efficiency in psychiatric hospital care. We used the method of data envelopment analysis (DEA), which finds increasing application in many spheres of public life, including healthcare. We subdivided the treatment facilities in the current study in three groups and estimated technical efficiency for each group. We present a possible assesment method, which provides an opportunity for improving efficiency in the sector.
Economic analysis and evaluation of the effectiveness of hospital care services in Bulgaria by using the Data Envelopment Analysis for the period 2010-2012
ABSTRACT In the current study, an economic analysis has been made on hospital activities that are... more ABSTRACT In the current study, an economic analysis has been made on hospital activities that are included in the project of the World Bank - ICB 008 to use specialized software for hospitals for the period 2010-2012. By using the Data Envelopment Analysis (DEA), this study aims to measure the level of overall and pure technical efficiency, and scale efficiency in the hospital sector and, in particular, to assess the use of the funding of hospitals through clinical pathways (CPs). Empirical data show that CPs as a method of financing have functioned at a level of 90% and above the overall technical inefficiency. Moreover, the contribution of the scale inefficiency in overall technical inefficiency is less than what is associated with a managerial inefficiency (i.e. pure technical inefficiency).
Destruction of expired medications – review of the regulations in Bulgaria
Scripta Scientifica Pharmaceutica, 2015
Therapeutic systems (TS) are contemporary drug delivery forms, designed to improve the therapeuti... more Therapeutic systems (TS) are contemporary drug delivery forms, designed to improve the therapeutic potential of drugs through maintenance of therapeutic drug levels for extended period of time. TS provide controlled or sustained drug release, intended to reach the systemic circulation or remain and act locally on the site of application. Transdermal Drug Delivery Systems (TDDS) are pharmaceutical preparations to be applied to the intact skin for systemic absorption and occupy more than 30% of the global market share of TS. TDDS ensure a constant plasma concentration of the active ingredients in the therapeutic window from 24 hours to 7 days by non-invasive and easy administration. Important advantages of TDDS include avoidance of first-pass metabolism and gastro-intestinal adverse effects, improved drug stability and etc. First generation TDDS (Transderm-Scop, Transderm-Nitro, Estraderm, Nicoderm and etc.) accomplish remarkable success and benefits in the treatment of motion sickness, angina pectoris, quit smoking and contraceptive therapy. The constantly growing scientific interest and adjustment of well-known physical and chemical methods (as iontophoresis, sonophoresis, microneedles and etc.) to TDDS as additional force to enhance drug permeation through stratum corneum, leads to next TDDS generations by overstepping beyond the preferable TDDS stereotype of the small, less than 300 Da, molecule with balanced lipophilicity. The number of the TDDS on the market increases every year, as the highest progress is observed in the field of Central Nervous System’s diseases - dementia, depression, Parkinson, migraine. The market share of TDDS on the global pharmaceutical market reaches up to 12% and is estimated to be approximately 31.5 billion, while their role and disposal on the Bulgarian market is still limited.
Stress tests of financial institutions are becoming more common in the midst of a global recessio... more Stress tests of financial institutions are becoming more common in the midst of a global recession and unpredictable future economic growth. We believe that apart from banks, stress tests can be conducted on hospitals as well and will have their merit. The proposed methodology for risk assessment in hospitals is only one of many possible solutions and has already been tested on the field. We demonstrate the results from such testing. Consequently, we propose the introduction of routine stress testing in the hospital care sector.
Prevention is the set of medical and non-medical events, which the public is taking to achieve be... more Prevention is the set of medical and non-medical events, which the public is taking to achieve better health and quality of life by isolating the risk factors, prevention of disease and reduce their effects (chronification or permanent incapacity and disability) and premature deaths. 3 Pre morbid prophylaxis-aimed at initial stage of contact between risk factor and susceptible individual and applicable to the entire population or risk groups 4 Primary prophylaxis-targeting specific causal relationships employed factors affecting in preclinical asymptomatic stage and applicable to the entire population selected groups of individuals or healthy persons 5 Secondary prophylaxis-aimed at early stage of a clinically manifest disease and applicable only in patients; 6 Tertiary prevention-aimed at late stage of the disease and applicable in patients.
Following the adoption of the Health Insurance Law in Bulgaria (1999), which provided the legal f... more Following the adoption of the Health Insurance Law in Bulgaria (1999), which provided the legal framework for the development of the voluntary health insurance, several health insurance funds had been established. Bulgaria had two licensed voluntary health insurance funds in 2001; in 2003 their number grew to six; and in 2009 this number stands over twenty. Despite the increased number of funds in recent years, their share of healthcare spending stayed at 1-1.5%, which is below European average. To this date, there are no serious and profound studies in the field among the scientific community in Bulgaria. The economic data published by the Commission of Financial Surveillance (CFS), conforms to EC regulations, but do not allow non-specialists to assess realistically voluntary health insurance funds (VHIF). This article introduces a methodology for comparing VHIF and establishment of a complex index (Benchmark Index-BI) based on 5 groups of indicators, related to several available variables. This index is intended as a tool for analyzing the voluntary health insurance sector and managing resources through a set of analytic indicators and variables. It can be used to create a certain type of ranking of VHIF.
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Papers by Petko Salchev
Данните по които се работи са на базата на предложението на БЛС за цени и обеми за 2024 година разпределено по специалности.
Приложен е метода на сравняване на два z-score, съответно за дейност и цена чрез графичен метод.