CEU Electronic Theses and Dissertations, 2015
| Author | Gotseva, Adelina Dimitrova |
|---|---|
| Title | Reducing Public Spending at Private Expense? Out-of-pocket Pharmaceutical Expenditure in Bulgaria after the 1998 Healthcare Reform |
| Summary | Bulgaria ranks among the countries in Europe with the lowest public expenditure on pharmaceuticals. In contrast, private expenditure usually expressed as out-of-pocket (OOP) payments represents a significant cost burden for some patient groups. Hence, foregone pharmaceutical consumption has often resulted in reduced health and economic benefits for patients themselves and society as a whole. Using three pharmaceutical consumption datasets from the World Health Organization for the period 2000-2006, IMS Health for 2009, and the European Commission for 2010, this thesis focuses on the post-2000 period to investigate the trends in private pharmaceutical expenditure in Bulgaria and to compare them to those in other European countries. It finds that over the period 2000 – 2010 following the 1998 Bulgarian healthcare reform which introduced social health insurance and out-patient pharmaceutical co-payment, Bulgaria has had one of the highest private out-patient pharmaceutical expenditure levels in Europe, and Bulgarian households have been paying an ever-increasing share of total pharmaceutical expenditure relative to income. Although OOP spending largely resulting from the patient co-payment mechanism is commonly recognized as beneficial to the public pharmaceutical budget, and it also decreases the demand-side moral hazard posed by patients, OOP expenditure on pharmaceuticals in Bulgaria is unsustainable in view of future fiscal and demographic challenges. The paper also investigates the factors that have potentially contributed to the high OOP spending, and provides policy alternatives to strengthening the financial protection of the Bulgarian health system. |
| Supervisor | Mihályi, Péter |
| Department | Economics MA |
| Full text | https://www.etd.ceu.edu/2015/gotseva_adelina.pdf |
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