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Policy challenges to the quality of child health services in Bulgaria
Author(s) -
Rechel Boika,
Spencer Nick,
Blackburn Clare,
Rechel Bernd
Publication year - 2010
Publication title -
the international journal of health planning and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.672
H-Index - 41
eISSN - 1099-1751
pISSN - 0749-6753
DOI - 10.1002/hpm.1030
Subject(s) - payment , transparency (behavior) , quality (philosophy) , public health , medicine , health care , business , nursing , family medicine , medical education , public relations , economic growth , political science , philosophy , finance , epistemology , economics , law
Background Our study aimed to explore policy challenges to the quality of child health services in Bulgaria. Methods The study was based on qualitative in‐depth interviews, analysis of regulatory documents, and review of the literature. Respondents included policy‐makers, providers and users of health services, from both rural and urban areas. Results Problems identified included insufficient training of general practitioners, medical errors, delays in response to emergencies, inadequate information provided to patients, and underdeveloped child public health. A common view was that paediatricians provide better quality care than general practitioners. Respondents described a lack of clinical guidelines for rational use of pharmaceuticals, overprescribing of antibiotics, reliance on pharmaceutical companies for information, and unrestricted sales of drugs over‐the‐counter. ‘Clinical pathways’, introduced as a payment mechanism in hospitals, were perceived as lacking transparency, complicating clinical practice, and forcing doctors to record wrong diagnoses and conduct unnecessary investigations. Conclusions Our findings indicate the need to develop evidence‐based clinical guidelines for primary and secondary care, establish payment mechanisms that facilitate quality improvements, promote rational use of pharmaceuticals, improve continuing training of physicians and strengthen child public health. Copyright © 2010 John Wiley & Sons, Ltd.