Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN:
1312-773X (Online)
Issue:
2025, vol. 31, issue1
Subject Area:
Public Health
-
DOI:
10.5272/jimab.2025311.5967
Published online: 28 January 2025
Original article
J of IMAB. 2025 Jan-Mar;31(1):5967-5973
WORKLOAD DYNAMICS OF MEDICAL PROFESSIONALS IN BULGARIAN HEALTHCARE SYSTEM: EVIDENCES FROM AGGREGATE DATA
Nikolay Atanasov1


, Krikor Indjian2
,
1)Department of Health Management and Health Economics, Faculty of Public Health, Medical University Plovdiv, Bulgaria.
2)Department of Languages and Specialized Training, Medical University Plovdiv, Bulgaria.
ABSTRACT:
Purpose. This study aims to analyze the tendencies of the workload of medical professionals in Bulgaria after the liberal reforms in the national healthcare system.
Material/Methods. Basic econometric methods, such as tests for structural breaks and dynamic rows modeling based on "macro-" or aggregate data, are implemented. The period covered is 1980-2023, twenty years before and twenty-four years after introducing market elements in national healthcare. Variables such as the number of patients discharged, consultations, doctors, and nurses are used to assess the workload level. Workload estimates are derived from a linear regression model of hospital output as the dependent variable with the number of doctors and nurses in the health system as factors. The model is tested for the stability of the regression coefficients (structural breaks) dated 2000.
Results. A structural break was found in 2000 in all three dynamic rows of doctors, nurses, and discharges. There was a well-defined increasing trend in the number of patients passing through the hospitals after the liberalization of the national healthcare system. In this condition, the number of medical professionals follows its own dynamics – a slight reduction for the group of doctors and a sharp decline for the nurses in the after-reforms sub-period. These facts indicate the presence of an increasing trend in the workload and intensity of medical labour. The dependence is well established, especially in the case of nurses.
Conclusions. This study confirms the hypothesis that the liberalization of the Bulgarian healthcare system, together with open-ended payment systems, caused an intensive growth of inpatient system output and workload. The expansion, especially for hospital facilities, which is not supported by a relevant number of medical professionals, threatens workplace performance and the quality of medical services.
Keywords: workload, medical staff, structural breaks, hospital discharges,
- Download FULL TEXT /PDF 641 KB/
Please cite this article as: Atanasov N, Indjian K. Workload Dynamics of Medical Professionals in Bulgarian Healthcare System: Evidences from aggregate data. J of IMAB. 2025 Jan-Mar;31(1):5967-5973. [Crossref - 10.5272/jimab.2025311.5967]
Correspondence to: Nikolay Georgiev Atanasov, Department of Health Management and Health Economics, Faculty of Public Health, Medical University Plovdiv; 15-A, Vasil Aprilov Blvd. Plovdiv 4002, Bulgaria; E-mail: Nikolay.Atanasov@mu-plovdiv.bg
REFERENCES:
1. Fournier PF, Montreuil S, Brun JP, Wilodeau C, Villa J. Exploratory Study to Identify Workload Factors That Have an Impact on Health and Safety: A case study in the service sector. IRSST. 2011. [Internet]
2. [135 years of social security in Bulgaria. Historical Overview of Social Insurance Legislation.] [in Bulgarian] NSSI. 2015: p.3. [Internet]
3. Gladilov S, Delcheva E. [Economics of Healthcare.] Fourth Ed. Princeps, Sofia. 2009. p.305. [in Bulgarian]
4. Stiglitz J, Rosengard JK. Economics of the public sector. Fourth Edition. New York, London: W. W. Norton Company, Inc. 2015. p.87-88. [Internet]
5. Busse R. Healthcare Systems: Towards an Agenda for Policy Learning Between Britain and Germany. Anglo-German Foundation for the Study of Industrial Society. Jun 2002, p. 24.
6. Böhm K, Schmid A, Götze R, Landwehr C, Rothgang H. Classifying OECD healthcare systems: A deductive approach. TranState Working Papers. No. 165. 2012; p. 22-24. [Internet]
7. Chow G. Tests of Equality Between Sets of Coefficients in Two Linear Regressions. Econometrica. 1960 Jul;28(3): 591–605. [Crossref]
8. Kaplan DM. Introductory Econometrics: Description, Prediction, and Causality. 3rd ed. June 2021. 13 Time Series: One Variable, p.231-232. [Internet]
9. Petrova G. [Trends and Prospects of Health Care Development in Bulgaria.] [in Bulgarian] Management and Education. 2013; 9(5):25-28. [Internet]
10. Vizjak M, Kaselj MP. Management of Migration of Personnel in Healthcare with an Emphases on Nurses and Technicians in the Republic of Croatia. Balkans JETSS. 2023 Dec;6(2):103-118. [Internet]
11. Rohova M, Koeva S, Dimova A, Mihailov N, Atanasova E, Koeva-Dimitrova L, et al. [Assessment of the functioning of the health system in Bulgaria.] [in Bulgarian] [monograph] Medical University Varna. 2023, pp. 93, 176. [Internet]
12. [Healthcare. A Brief Statistical Guide. 2000.] [in Bulgarian] Ministry of Health, NCPHA, Sofia. 2001, pp.29, 34. [Internet]
13. [Healthcare. A Brief Statistical Guide. 2024.] [in Bulgarian] Ministry of Health, NCPHA, Sofia. 2024, pp.52, 60. [Internet]
14. Law on the budget of the National Health Insurance Fund for 2012.] [in Bulgarian] State Gazette, no. 99 of 16.12.2011. [Internet]
15. [Law on the budget of the National Health Insurance Fund for 2022.] [in Bulgarian] [Internet]
16. Cordero-Guevara JA, Parraza-Díez N, Vrotsou K, Machón M, Orruño E, Onaindia-Ecenarro MJ, et al. Factors associated with the workload of health professionals in hospital at home: a systematic review. BMC Health Serv Res. 2022 May 26;22(1)704. [PubMed]
17. Asamani J. Amertil N. Chebere M. The influence of workload levels on performance in a rural hospital. Br J Healthcare Manag. 2015; 21(12):577-586. [Crossref]
18. Kovacs R, Lagarde M. Does high workload reduce the quality of healthcare? Evidence from rural Senegal. J Health Econ. 2022 Mar; 82:102600. [PubMed]
19. Patel SH, Stanton CL, Miller SG, Patrie JT, Itri JN, Shepherd TM. Risk Factors for Perceptual-versus-Interpretative Errors in Diagnostic Neuroradiology. AJNR Am J Neuroradiol. 2019 Aug;40(8):1252-1256. [PubMed]
20. Portoghese I, Galletta M, Coppola RC, Finco G, Campagna M. Burnout and workload among health care workers: the moderating role of job control. Saf Health Work. 2014 Sep;5(3):152-7. [PubMed]
Received: 27 May 2024
Published online: 28 January 2025
back to Online Journal