B I Las - The public administration of exogenous and endogenous risks of regional development in post-crisis period - страница 33

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UDC 61 (497.2)

STATE OF THE HEALTH WORKFORCE IN BULGARIA ACCORDING TO INFORMATION FROM NON-SPECIALIZED

DAILY PUBLICATIONS (1988-2009)

A.A. Marcheva, Assistant professor, PhD, D. Tsenov Academy of Economics, Bulgaria

I

The study of the state of health workforce aiming to formulate the problems and search for solutions is based on various information resources. Before we start searching for information we may create a list of question on health workforce state. A "10x10" format is proposed.

№10 QUESTIONS

(Questions that will always retain relevance when investigating health workforce for management purposes)

I. NUMBER AND STRUCTURE OF HEALTH WORKFORCE

1.1. What is the real number of the health workforce?

1.2. What is the proportion between different personnel categories?

1.3. How many physicians, dental doctors and masters of pharmacy are not practicing their profession?

1.4. What is the proportion between workforce engaged in state and municipal health establishments and those in private health establishments?

1.5. What is the percentage of occupied positions?

1.6. What is the growth rate? Decrease of workforce in healthcare?

1.7. What is the real coverage per 100000 of the population with specialists from different groups - total and by region?

1.8. What is the proportion "Physician - middle-level medical personnel (healthcare specialists)"?

1.9. What is the proportion "Patients - healthcare specialists"?

1.10. What are the differences between the coverage of the Bulgarian population, that of EU and the regulations of WHO?

II. AGE and gender STRUCTURE

2.1. What are the key differences in the age and gender structure of health workforce and in the rest of the economy?

2.2. What is the minimal and maximal age by sex in separate health workforce categories?

2.3. What is the average age of health workforce in Bulgaria and EU?

2.4. What is the average age of post-graduate students, total and by sex?

2.5. Which age group is most affected by structural changes in healthcare?

2.6. What is the sex ratio in separate age groups?

2.7. Is there an upper age threshold for working in healthcare?

2.8. Are there any studies of morbidity and mortality among age groups?

2.9. Which age group is most prone to changes in workplace?

2.10. What is the average life expectancy of different healthcare workforce categories?

III. EDUCATIONAL POTENTIAL

3.1. What are the educational stages undergone by healthcare workforce?

3.2. What educational establishments carry out the training of healthcare workforce?

3.3. What is the number of students enrolled in medicine and public health in different educational degrees?

3.4. For which educational degrees and specialties the diplomas are internationally recognized?

3.5. How the practical training of students in different educational degrees is carried out?

3.6. What are the criteria for selection of post-graduate students?

3.7. What are the options for continuing education in the country?

3.8. What are the opportunities for training, qualification and specialization abroad?

3.9. What forms of international cooperation are practiced in order to boost the educational potential of healthcare workforce?

3.10. What is the rational proportion between workforce categories with different educational potential?

IV. LABOUR REGULATIONS

4.1. Which legislative decisions have determined the profile of health workforce?

4.2. What is the role of health specialists in developing legislation and law making?

© Marcheva A.A., 2011

4.3. How do labour laws and health standards interact?

4.5. What is the length of the working day for different workforce categories?

4.5. Is it possible to regulate the duration and intensity of labour in healthcare?

4.6. What penalties are provided for in the event of labour law violations?

4.7. Is labour remuneration regulated for all health workforce categories?

4.8. What are the differences in labour remuneration by workforce category and by region?

4.9. How are rights and responsibilities of different health workforce categories regulated? 4.10. What are regulated working conditions?

V. CODE OF ETHICS

5.1. Is there a contemporary version of the Hippocratic Oath?

5.2. Is there a code of ethics applicable to healthcare workforce?

5.3. What are the ethical relationships between different personnel categories?

5.4. What are the ethical relationships between personnel and patients?

5.5. Does higher remuneration contribute to the observation of ethical standards?

5.6. What are the ethical relationships between different trade unions?

5.7. What are the ethical relationships between trade unions and non-governmental organizations?

5.8. What is the responsibility of top level management in the event of bankruptcy of the health establishment?

5.9. Are ethical rules being violated?

5.10. Medical ethics and corruption?

VI. national HEALTH MAP

6.1. The national health map is a document of legislative or indicative character?

6.2. What is the participation of interested parties in the development of the national health map?

6.3. What international standards for population coverage and accessibility of health establishments are used in the development of the national health map?

6.4. What is the coverage of the national health map with specialist from different educational levels?

6.5. What indicator groups are used in the development of the national health map?

6.6. Will the adoption of the national health map violate the market principles?

6.7. Is the adoption of the national health map in contradiction with the interests of the workforce?

6.8. What is relation between new health facilities and the National health map?

6.9. Which health workforce categories are presented in the National health map? 6.10. When and who may make changes to the National health map?

VII. MIGRATION

7.1. Which circumstances are the reasons for healthcare workforce migration?

7.2. What is the proportion immigration/emigration by personnel category?

7.3. Can we speak of an established international market for healthcare workforce?

7.4. Is regulation of migration processes possible in the event of deficit in some workforce categories?

7.5. Which group is the most mobile?

7.6. Which are the factors for internal migration (territorial and between categories)?

7.7. What is the role of public and private intermediaries in amplifying internal migration?

7.8. Does Bulgaria gain or lose due to immigration/emigration?

7.9. What is the role of top management in the regulation of migration processes?

7.10. Are there official statistics for health workers working abroad?

VIII. salaries and material incentives

8.1. What is the ratio of salaries and social and health insurance contributions of medical and non-medical personnel compared to all expenditures in healthcare?

8.2. Are there any differences in remuneration by personnel categories in different medical (university, regional, municipal, private, etc.) and health establishments and if there are - what is their scope?

8.3. What forms of material incentives are used in healthcare?

8.4. How National health map will affect the health workforce salaries?

8.5. Is there a relationship between labour remuneration and personnel migration and if there is - for which personnel categories it is most significant?

8.6. What is the difference in salaries by personnel categories in Bulgaria and EU-15 countries with the most Bulgarian medical personnel? (Great Britain, Italy, Spain, Germany, Belgium, etc.)

8.7. What is the proportion between labour remuneration in Bulgaria and new EU-members from Eastern Europe?

8.8. Is there a difference between corruption and unregulated payments?

8.9. What are the amounts of non-regulated payments? 8.10. What are the most popular non-material incentives?

iX. TRADE UNIONS/PROFESSIONAL AND NON-GOVERNMENTAL ORGANIZATIONS

9.1. Which are the officially registered trade/professional unions in healthcare?

9.2. What protection is provided to healthcare workforce by trade unions?

9.2. What are the relationships between officially registered trade/professional unions, the Ministry of Healthcare and NHIF?

9.3. What is the participation of officially registered trade/professional unions in establishing the national health policy?

9.4. How trade unions protect the interests of their members?

9.5. What negative trends are monitored in the management of trade unions?

9.6. How many non-government organizations are officially registered and interested in conducting healthcare related activities?

9.7. How many healthcare professionals work in non-government organizations and do not practice their specialties?

9.8. Are non-government programs and projects helpful in terms of promoting education and qualifications of workforce?

9.9. What is the participation of NGOs in the healthcare policy-making?

9.10. What is the involvement of health workforce in various patient organizations?

X. INTERNATIONAL COOPERATION

10.1. What forms of international cooperation are most widely used?

10.2. What is the effect of foreign investments inflows in healthcare on the promotion of international cooperation?

10.3. What is the participation of educational institutions in international programmes?

10.4. Which international organizations have Bulgarian trade unions as members?

10.5. What is the role of international cooperation in the formation of new professional trends?

10.6. How funds from Operational Program's for adoption of good international practices are utilized?

10.7. What is the number of foreign students in Bulgaria Medical Academy and Medical Universities?

10.8. What is the number of Bulgarian students in Medical Academy and Medical Universities abroad?

10.9. Who and how regulates specializations abroad of Bulgarian health workforce? 10.10. Which is the best form of international cooperation for health workforce?

II

Greater and greater attention has been paid to non-specialized publications as a source of information over the last years. The topics related to the needs of health and healthy way of life, on one hand, and to the healthcare system's development and functioning, on the other hand, are widely presented in the media.2

Non-specialized daily publications, as part of media space, are one of the sources of "symptomatic" information on problems when satisfying needs for health and healthy lifestyle, in which a special role belongs to health workforce.3

The International institute of healthcare and health insurance can be recognized as a leader in Bulgaria in offering services related to media analysis.4

The study is carried out based on 600 publications from the period 1988-2005 viewing issues related to health, healthy way of life, healthcare system's resources, its organization and the impact of environment on its functioning and development.

The first stage is selection. Publications used in the cross section are chosen randomly from a large volume of publications collected in the course of more than 20 years. Each one of them is drawn randomly from a "pool" containing all the publications. All publications "participating" in the draw are preserved. The titles of the 405 studied publications, listed chronologically according to the year of their publication, are given in the first table "Random sample of non-specialized publications in Bulgarian daily press in the period 1988­2002".

Table 1

Random sample of non-specialized publications in Bulgarian daily press

_in the period 1988-20025_

Consecutive number

Title of publication

Year of publication

1

There is a reason for the consequences. (Nation-wide discussion: The health welfare of the nation)

1988

2

Health insurance fund to be created

1989

3

The (Un)Healthy student

1990

6

In health care - radical changes

1991

8

"The Chirkov phenomenon" - always gets what he wants

1992

22

Childless families in the country are losing their last hope. 480 thousand are necessary for the Board of sterility at First Obstetric Hospital Tina Kirkova not to stop work

1993

41

The number of paid medical services is not increasing. Regulatory perversions reach into the pocket of the sick, but nobody can prove and punish corruption.

1994

45

Memories that villagers had a resort base are fading

1995

48

20 thousand people involved in heroin abuse in Bulgaria (19 addicts died in Sofia alone)

1996

59

31,000 will be the price of a day in the hospital (A new regulation on paid medical services enters into force)

1997

89

"Support" is against the Health Act (Varna District Hospital on the verge of bankruptcy?)

1998

155

4,5 million BGN for medicines for AIDS patients

1999

243

"First Aid" threatens to go on hunger strike. (Today, medical staff will seek the resignation of the President of the medical association, Dr. Ignatov)

2000

200

326 are carriers of AIDS in Bulgaria (Bulgarian scientists will stop the HIV virus with liposome microcapsule)

2001

311

Balkanfarma - up to 19% jump in locally produced medication

2002

405

Surgeons are considered the most corrupt. (Every third person does not believe in the success of the healthcare reform. People are against cash on hand and expensive drugs)

2002

The significant number of titles from the period 1997-2002 can be explained both by the sharp rise in the number of publications after the mid-90s and by the increased interest to the new issues related to the structural reform in healthcare system, the change in the way of funding, the population's health security against the background of the "unfriendly" surrounding socio-economic and ecological environment, etc.

At the second stage the publications are presented by title and year of publishing. This section of the study is supplemented by sorting according to year of publishing as presented in the second table "Distribution of publications by year".

2

In the media space there are lots of specialized print editions. The Zdraven Front newspaper founded in 1945 with a circulation of 2000 is the only one in 1989. In 1990 it was renamed into "Forum Medicus". In 1994 the group of newspapers on health topics increased to 26 with a circulation of 1543800, and in 2000 the editions are 18 with a circulation of 3070900. The topics of these editions are presented in the following trends: scientific medicine, natural and eastern medicine, diseases, treatment methods; healthy way of life. For more details see Milusheva, R., Petrova Y. Statistical review of the newspapers published in the Republic of Bulgaria for the period 1989-2000 - Statistics, 3, 2002, pp. 64-65. In 2005 there were 20 newspapers published in the rubric of the Unified decimal classification "Medicine and public health" with a yearly circulation of 8760.2 thousand, 555 issues. -BULGARIA 2005. Socio-economic development, Sofia, NSI, 2006, p. 281.

3 In 1998 in Bulgaria 644 newspapers were being issued, including 53 daily newspapers with an annual circulation of 316070.1 thousand; in 2007 the number of news papers is 448, including 64 daily newspapers with annual circulation of 159416 thousand.

4 In the archive of the Institute there are over 280000 publications from print editions (after 1* January 2001) and materials from the main radio stations, televisions and internet media (after 1st January 2003) in Bulgaria. About 250 materials enter the IHHII database daily. http://mediamonitoring.zdrave.net

5 The table is made up of a sample out of the 405 publications and lists the first title of each year. For 2002 it contains the first and last title.

Table 2

Year

Distribution of publications by year Consecutive number

Number of publications

1988

1

1

 

...

 

1999

155-242

88

 

...

 

2002

311-405

95

Total years 15

Total consecutive numbers 405

Total number of publications 405

Two measurements are used for making table 3 at the third stage of the study - terminology and subject-matter and consecutive number of the title list.

Table 3

_Two-dimensional measurement of publications - terminology and subject-matter and consecutive number in the title list6

Thematic nests

Terminology and subject-matter

Frequency of presentation

1

Administration, medical

1

18

Laws, Healthcare Law, Law on Health Insurance (Health insurance Act)

15

19

Closure: beds, hospitals, centers, places.

5

20

Salary, labour remuneration

9

26

Health map

179

26

Health fund, NHIF

29

31

Health experts

2

35

Health ministry, Health Minister, Head of Healthcare

8

37

Names

22

42

Quality of services

1

44

Control, responsibility

4

47

Physician, Medicsl, General Practitioner, Family Physician, Nurses, Laboratory assistant, Hospital Attendant, Medics, Medical Association

66

51

Medical Academy

2

54

Training, Educational Institutions, Study Abroad

4

58

Payment, pay for health, health contributions, medicine, out of pocket

17

59

Policlinics

10

61

Practice, practicing

4

63

Registration, companies (establishments), Dealers

3

76

Services, Service, Help, Medical

7

77

Scientists

3

78

Students, Student Health

4

79

School Health

7

82

Private practice, work in private, private services

33

83

Countries

 

Three measurements are used for making table 4 at the forth stage of the study - thematic nests (terminology and subject-matter), year of publication and consecutive number of the title list.

Table 4

Three-dimensional measurement of publications - terminology and subject-matter, year of publication and consecutive number of

the title list

Year

1988­1996

1997

1998

1999

2000

2001

2002

Consecutive number

 

 

 

 

 

 

 

 

 

 

 

 

 

300­310

 

Terminology and subject-matter

1-58

59-88

89-154

155-242

243-299

 

311-405

1. Administration, medical

 

71

96

 

 

 

 

 

 

 

 

 

 

 

 

20. Salary, Labour remuneration

 

 

118

192, 195, 210, 226, 231

271

 

313, 342

 

 

 

 

 

 

 

 

47. Physician, Physicians,

14, 53

75

92,

156, 163, 169,

243, 245, 246,

303,

320, 326,

Medical, General Practitioner,

 

 

106,

170, 173, 174,

251, 253, 255,

307

327, 340,

Family Physician, Nurses,

 

 

133,

176, 178, 181,

258, 262, 264,

 

350, 365,

Laboratory assistant, Hospital

 

 

144,

187, 196, 199,

265,267, 273, 275,

 

370, 401,

Attendant, Medics, Medical

 

 

145

201, 210, 212,

281, 285, 286,

 

403

Association

 

 

 

216, 218, 219, 232,233, 238, 239

287, 288, 295

 

 

83. Countries I I I I 191, 216 | | | 371

The constructing of table at the fifth stage expands the possibilities for analysis of media space. This table can be named both "Multidimensional measurement of publications" and "Analytical matrix". It presents each publication by: 1) Consecutive number; 2) title of publication; 3) year of publication; 4) main issue discussed in the publication; 5) user affected by the problem; 6) servicing structure in which it arose or which takes part in solving the problems; 7) necessary resources for solving the problem - material (M), financial (F), work force (WF), informational (I), organizational (O); 8) measures undertaken for solving the problem; 9) state of the problem as of December 2002.

6 Out of the 83 thematic nests sorted alphabetically the table displays those that are related to healthcare workforce to the greatest extent

Table 5 is made up as a sample of multidimensional measurement of publications, which shows only 22 titles chosen randomly, among which the first and the last ones in the list. With the aim to "match" the problems outlined in the publications with the separate 83 thematic nests it is necessary to go back to one of the previous tables (tables 3 and 4). Such an operation reveals repetitive problems in time and territory aspects. A mismatch between thematic nests and problems is possible - there is a greater variety among problems.

Table 5 offers possibilities for marking fields, which are in contact with problems of health workforce in specialized publication and official documents of state institutions.

The tone in most of the non-specialized publications is critical, caused by the pungency of the problems. The tonalities used in specialized publications and in non-specialized publications are very often in "disharmony". Exactly this "disharmony" must be "heard" or caught by institutions, forming the integrated health politics.

In each of the presented trends for studying publications summing up-generalization of problems is possible; grouping consumers and forming a target audience; problem institutionalization and combining organizational efforts; integration of the resource potential to "attack" common problems or to look for new sources of resources and optimal use; outlining measures; new layout of problems unsolved prior to

2002.

The finishing, ninth measurement of publications, is like "ninth tone" of the scale. A great number of the established problems, regardless of the period (1988-2002), are unsolved or partially solved. There are problems which are intensified or because of their untimely solving they give rise to new ones - harder and requiring significant resources for solving them.

In each of the presented trends for studying publications summing up-generalization of problems is possible; grouping consumers and forming a target audience; problem institutionalization and combining organizational efforts; integration of the resource potential to "attack" common problems or to look for new sources of resources and optimal use; outlining measures; new layout of problems unsolved prior to

2002.

The finishing, ninth measurement of publications, is like "ninth tone" of the scale. A great number of the established problems, regardless of the period (1988-2002), are unsolved or partially solved. There are problems which are intensified or because of their untimely solving they give rise to new ones - harder and requiring significant resources for solving them.

A second iteration (comprising 6 stages) with 300 publications from 2005 was created in order to verify the situation, described at the 5-th stage table. The second iteration includes a new 6-th stage in which the examined situation in 2005 is compared against that for the period 1988-2002. At this stage evaluations for the status of human resources in healthcare are generalized in a new table. A significant number of the problems remain unsolved in spite of the political will demonstrated after the parliamentary elections in 2005.

Publications in non-specialized daily press for the period January-December 2005, with titles directly related to healthcare workforce

(54 out of300)

4. Help, we are being medically treated!

7. BGN 360 000 in fines collected by the NHIF in Plovdiv.

10. Medical examination to become compulsory.

18. Chaos and default of pharmacies starting in December

23. Shterev on foot in Konevo due to riot

27. The medical association saved 20 thousand from business trips

31. A missing ordinance unties the hands of healers

35. Nurses association under discussions

40. Thank you doctor, and what are your pains?

43. No-good laws protect no-good doctors.

51. Beam instead of scalpel

55. Patients and physicians discuss health separately

58. Ophthalmologists from around the world gathered in Bulgaria

63. German professor operates the hearts of young Bulgarians pro bono

65. GPs were the worst paid

67. Prominent oncologists will carry out consultations in Bulgaria

71. Stethoscopes are put away, we will be treated electronically

72. Physicians cash registers under scrutiny

76. The health services market is no a street-stall

78. Physicians in private practices get 200 BGN less that teachers

84. Blood-free operations of the aorta are possible in Bulgaria too

87. Replacing dentists with.. toothpaste

94. Half of the physicians in Varna - passionate smokers

98. Our dentists in EU - dental physicians

118. We will restore the physicians in large schools

136. Physicians to be entered in a national registry

137. Germany is looking for our nurses and physicians 158. The medical holding in Sofia disappeared too 162. XXI-st century and healthcare prevention

165. Salaries in St Ecatherine up to 3000BGN

176. Four with honorary sign "Bulgarian Physician"

190. Gaydarski is firing hospital bosses

195. Hospital payments put ministers and deputies in quarrel

197. Congress on Bulgarian medicine

199. Therefore - let's make a deal

204. "Physician of the year" awards

213. Pharmacists trade unions allowed

225. Physician caught with 40 BGN bribe

231. Another unique transplantation in "Lozenets"

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