Bulgaria under the guidance of theMinister of Health is undertaking a major reform of itshealth system. One input to the reform is a joint study withthe World Bank on health financing in Bulgaria (The WorldBank Diagnostic Report). The report evaluates the strengthsand weaknesses of Bulgaria’s health financing system interms of the three health financing functions of revenueraising, risk pooling, and purchasing of services. Itassesses each of these financing functions in terms of thehealth financing goals of improving health outcomes,financial protection, and consumer responsiveness in anefficient, equitable, and sustainable manner. The assessmentof the health financing system documented significantstrengths in the system, but also major challenges in termsof the purchasing function and current hospital paymentpractices. These challenges included unsustainable growth inhospital spending; lack of incentives for efficiency,quality, or cost control, and strong incentives forhospitalization over treatment in less expensive outpatientsettings. Fundamental problems with the current hospitalpayment system using Clinical Care Pathways (CCPs) werehighlighted. The purpose of this report is to provideinformation to Bulgarian decision-makers on how Bulgaria canmove towards implementing a DRG-based hospital budgeting andpayment system. The report was prepared by a team ofBulgarian and international DRG experts who have beeninvolved in the country’s DRG assessment and planning sinceits inception. The report is intended for a wide-rangingaudience that includes high-level policy-makers who areweighting the benefits of implementing DRGs, technical staffwho may be tasked with implementing the Action Plan, andother key stakeholders who may be less familiar with the useof case-mix as a mechanism to provide payment to hospitals.
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