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Background In Bulgaria, following the reforms in healthcare, the Health insurance model and the role of GPs have been adopted as a key figure for primary outpatient medical care. Part of the obligations of the GPs for the implementation of the individual contracts with RHIF are also the preventive examinations of the mandatory health-insured persons over the age of 18 and the formation of risk groups of the population. Since 2006, the overall prophylactic review is mandatory for all health insured persons over the age of 18, regardless of their health status. It includes a core set of activities and studies that identify both people with disabilities and patients at increased risk of developing certain socially significant diseases such as cardiovascular, malignancies and diabetes. Material and methods Data were collected by documents review and direct individual self-administered questionnaire among 513 persons from the Pleven region and 229 GPs from three districts in the country. Results Despite the mandatory nature of general checkup for all persons over ’18, annually recognizes low range (from 35.8 to 45%). It was found that people over 65 who have chronic diseases more regularly visit the GP for check-up. The main reasons for the low population coverage are: lack of time and motivation of GPs; high relative share of persons with discontinued health insurance rights (over 20%); insufficient awareness and dissatisfaction of the mandatory health insured persons about mandatory prophylactic examinations. Of the respondents, 48% do not know what activities are involved, and 39% consider that the reviews are carried out formally. Conclusions Prevention of health-insured persons over 18 years of age is low in scope and is mostly opportunistic. In order to optimize the health and economic impact of the prophylactic review program, it is appropriate to provide for motivation measures for both GPs and those subject to the scope. Key messages In Bulgaria, the range of persons over 18 years old with prophylactic examinations is low. Prophylaxis of the persons covered is mostly opportunistic.

Basic problems in conducting a general preventive review of persons over 18 years of age in Bulgaria