Citizen control in primary outpatient care – opportunities and realities in Bulgaria

Abstract

The signifi cance of control increases with the push towards improving the overall eff ectiveness of the health insurance system. In order for public resources to be spent lawfully and eff ectively, there needs to be increased control not only from the National Health Insurance Fund (NHIF), but citizen control also needs to be incorporated in the process. 
Materials and Methods: The goal of this survey is to analyze the opportunities for implementing citizen control over the spending of public health funds and compare them to the real conditions as far as the outpatient medical care level. Legislation and news from NHIF’s webpage related to citizen control opportunities were studied. A direct, anonymous survey was carried out on the Google forms platform amongst Bulgarian citizens past the age of majority. Results: The results of the questionnaire survey carried out between 24.06.2022 and 16.10.2022 among 1045 adults with compulsory health insurance from all over the country, showed that they were poorly informed on the opportunities for citizen control which have been regulated and created in practice and don’t take advantage of them. Only 45,6% of the participants were aware of the digital services “Record review for health-insured persons”, which is found on NHIF’s webpage, and less than half of them (42,8%) used this service. The NHIF’s mobile application for feedback was used by as little as 11,8% of the respondents, and only seven patients have used it to share an opinion, while nine have used it to get notifi cations for data changes in their patient record. The portion of participants who have taken part in NHIF inquiries was also very small – 2,5%. Merely 2,8% have posted a complaint to the NHIF after being denied medical services. 
Conclusions: All of this makes it evident that a change is necessary in order for citizen control to be strengthened as a mechanism. This will lead to the correction of proven deviations in reported medical activities and will make it easier to get the patients’ opinions on the medical care they have been provided with.