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The Bulgarian Model of Integrating Military and Civil Health Care System. Lt.C. (R), Assoc. Prof. Kamen KANEV MD PhD, Brig. Gen. Prof. Stoyan TONEV MD PhD, Col. (R), Prof. Dimitar LEKOV MD PhD MILITARY MEDICAL ACADEMY, SOFIA, BULGARIA. - PowerPoint PPT Presentation
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The Bulgarian Model of Integrating Military and Civil Health Care
System
Lt.C. (R), Assoc. Prof. Kamen KANEV MD PhD,
Brig. Gen. Prof. Stoyan TONEV
MD PhD,
Col. (R), Prof. Dimitar LEKOV
MD PhDMILITARY MEDICAL ACADEMY,
SOFIA, BULGARIA
The reform of the Bulgarian Healthcare System has both a social and health price for the civilian population and major significance for the development of the Bulgarian military and civil medicine as a whole.
The aim of this study is to investigate the integration of the Military and Civil Healthcare System while the Reform in the Health Care System takes place in order to diminish the negative social and health effects on the civil population.
Under the conditions of reforming Civil Healthcare System, Military Healthcare System, especially Military Medical Academy resolves not only military medical tasks and problems in the country and abroad but opens its doors to the civilian population in the whole country.
MISSIONS
MILITARY MEDICAL ACADEMY IS A MULTI-PROFILE MEDICAL FACILITY STRUCTURED TO PROVIDE BULGARIAN ARMED FORCES WITH UP-TO DATE MEDICAL CARE FOR THE SOLDIERS, AND TO ACT AS A PART OF THE NATIONAL HEALTHCARE SYSTEM
DECREE OF COUNCIL OF MINISTERS
#119/13.06.2002
GOALS
ACCOMPLISHMENT OF THE HEALTH REFORM IN MEDICAL SUPPORT IN ACCORDANCE WITH MILITARY DOCTRINE AND PLAN 2004
ACHIEVEMENT OF THE REQUIRED CAPABILITY TO PROVIDE MEDICAL SUPPORT TO THE FORCES ACCORDING TO NATO STANDARTS
MMA-MODMEDICAL FACILITIES FOR
OUT-PATIENT AND IN-PATIENT CARE
ADMINISTRATION
Research Center for radiological, biological, and chemical protection
Center for military epidemiology and
hygiene
Mil Med Det Em Res with branches
Departments, chairs, clinics, laboratories
- therapy- surgery-neurology, psychiatry, neurosurgery- image diagnosis- laboratory- emergency and intensive care- healthcare operations- disaster medicine
Center for military medical expertise and
aviation medicine
Rehabil Hospitals
- Hissar- Pomorie - Bankya
MIL H - Varna
MIL H - Sliven
MIL H - Pleven
Medical Department - GS
Medical Department Army
HQ
Medical Department AF HQ
Medical Department Navy
HQ
Central Depot Lovech
Troop medical units Troop medical units Troop medical units
MIL H - Plovdiv
SPECIFIC TASKS
DIAGNOSIS, TREATMENT AND REHABILITATION FOR ALL WHO NEED MEDICAL CARE FROM THE ARMED FORCES AND CIVILIAN POPULATION
PROPHYLAXIS OF DISEASES AND INJURIES//PREVENTIVE MEDICINE SANITARY CONTROL ENVIR. CONTROL/
MEDICAL SUPPORT OF COMBAT TRAINING AND PHYSICAL TRAINING
MEDICAL EXPERTISE OF FITNESS FOR MILITARY SERVICE
SCIENTIFIC RESEARCH IN MILITARY MEDICINE
MILITARY MEDICAL TRAINING AND POSTGRADUATE MEDICAL TRAINING
READINESS FOR CRISIS RESPONSE OPERATIONS
MEDICAL SUPPORT OF MISSIONS ABROAD /INTEROPERABILITY WITH NATO COUNTRIES/
MEDICAL EVALUATION
MEDICAL LOGISTICS
ELABORATION OF MEDICAL KITS AND MODULES
STRUCTURE OF MMA
MULTI-PROFILE HOSPITAL BASE FOR ACTIVE TREATMENT – SOFIA
HOSPITAL BASES FOR ACTIVE TREATMENT – VARNA, PLOVDIV, PLEVEN, SLIVEN
HOSPITAL BASES FOR BALNEOLOGY, REHABILITATION AND PROPHYLAXIS – HISSAR, POMORIE, BANKYA
CENTER FOR MILITARY MEDICAL EXPERTISE AND AVIATION MEDICINE
CENTER FOR MILITARY EPIDEMIOLOGY AND HYGIENE
RESEARCH CENTER FOR RADIOBIOLOGICAL, BIOLOGICAL AND CHEMICAL PROTECTION
MILITARY MEDICAL DETACHMENT FOR EMERGENCY RESPONSE / URGENT MILITAY MEDICAL UNIT/
TROOP MEDICAL UNITS
PERSONNEL and NUMBER OF BEDS
MEDICAL DOCTORS – 300DENTISTS – 5NURSES – 460OTHER PERSONNEL – 555
PROFESSORS – 8ASSOC. PROFESSORS – 44ASSISTANT PROFESSORS – 38DOCTORS OF SCIENSES – 10DOCTORS - 64
MPHBAT -SOFIA 581
HBAT-PLOVDIV 120
HBAT-SLIVEN 100
HBAT-VARNA 280
HBAT PLEVEN 100
HBBRP-BANKYA 120
HBBRP-HISAR 215
HBBRP-POMORIE 150
With its five hospital facilities for active treatment in Sofia, Plovdiv, Varna, Pleven, Sliven, as well as the hospital facilities for continuous treatment and rehabilitation in Bankya, Hissar and Pomorie, the Military Medical Academy provides highly qualified and specialty diagnostics, treatment, rehabilitation and prophylaxis of military and civilian patients in the entire country.
HOSPITAL FACILITY FOR ACTIVE TREATMENT (HFAT) - VARNA
A hospital with 280 beds and a diagnostic-consulting block, providing full range of specialized medical services for the military contingent and the civil population of North-Eastern Bulgaria. At HFAT – Varna, there are established: Clinic of Internal Diseases, Department of Surgery, Clinic of Orthopedics and Traumatology, Clinic of Toxicology, Thermal Trauma Ward, ENT Ward and Ophthalmologic Ward. The excellent equipment and the high-qualified specialists allow HFAT – Varna to be a referral hospital for thermal trauma and intoxication treatment for the North-Eastern region of Bulgaria, and an educational base for the Medical University of Varna.
HOSPITAL FACILITY FOR ACTIVE TREATMENT - PLOVDIV
The Hospital Facility for Active Treatment – Plovdiv is a health establishment with 100-years history and rich traditions in the structures of the Bulgarian Army. The health reform enabled the hospital to sign a contract with the Health Insurance Fund and to render health care to all who wish. The hospital has an Admission-Consulting Block, where 8 functioning rooms (therapeutic, neurological, surgical, orthopedic, ENT, dental, and dermatological), diagnostic laboratories (Clinical Analyses Ward, Pathology Ward, Microbiological Laboratory), as well as Image Diagnostics Ward. The hospital has 120 beds in 8 clinic units: Internal Medicine Clinic, Clinic of Surgery, Clinic of Neurology and Psychiatry, ENT Ward, Dermatology and Venereal Diseases Ward, Ophthalmologic Ward and Physical Therapy Ward. HFAT - Plovdiv, as a branch of the Military Medical Academy-Sofia uses preferentially the diagnostic and therapeutic capacities of this leading healthcare establishment in the country – nuclear magnetic resonance imaging, computer tomograph scanner, lithotripter, hyperbaric chamber, etc.
HOSPITAL FACILITY FOR ACTIVE TREATMENT (HFAT) - PLEVEN
HFAT is established in 1903 by a Decree of King Ferdinand as a Ninth Division Hospital for the purpose of medical provision of the army in Central North Bulgaria. This is a commitment the hospital has performed till present. The following units are functioning at HFAT - Pleven: diagnostic-consulting block and wards of surgery, internal diseases, neurology, physical therapy, anesthesiology and intensive care. Along with the regulatory assigned contingent, civilians may get healthcare at the hospital under the clinical pathways contracted with the Health Insurance Fund (asthma, diabetes, inguinal hernia, cardiac rhythm disorders, acute appendicitis, pneumonia, heart failure, chronic obstructive pulmonary disease, chronic diseases of tonsils).
HOSPITAL FACILITY FOR ACTIVE TREATMENT (HFAT)- SLIVEN
Hospital Facility for Active Treatment in Sliven is integrated part of the MMA, providing healthcare to the military contingent of Southeastern Bulgaria. It has Diagnostic Consulting Block including: X-ray ward, Functional Diagnostics, Laboratory and Consulting-Reception Rooms. The Stationary Block has 100 beds in 12 wards: Surgery, Emergency and Septic Surgery, Urology, General Therapy, Cardiology, ENT, Anesthesiology Reanimation and Intensive Care Unit, Infectious Diseases, Physiotherapy and Pathology. Civilians have the right to be treated in HFAT - Sliven under the 23 clinical pathways contracted with the Health Insurance Fund
HOSPITAL FACILITY OF BALNEOLOGY, REHABILITATION
AND PROPHYLAXIS – BANKYA
The major sanative factors of the town of Bankya are the mineral waters (hydrothermal, hydrocarbonate-sulphate-sodium, silicon and lightly fluorized) and the climate (moderate continental with foot-of-mountain influence).The hospital facility of Bankya is specialized in treatment and rehabilitation of cardio-vascular and brain diseases and post-surgery conditions: valvular heart diseases with heart failure up to 1st degree; cardiac defect post-surgery conditions; ischemic heart disease; conditions following myocardial infarction, compensated forms of myocardial dystrophy, 1-2 stage hypertension disease; atherosclerosis in early stage, angioneurosis and 1-2 stage Raynaud's disease; 1-2 stage Burger's disease; atherosclerotic arterial obliteration of extremities - up to the 2 stage; functional disorders of nervous system. A favorable influence is observed in some light forms of thyreotoxicosis, light forms of diabetes, obesity, chronic neuralgia and neuritis, chronic gastritis and colitis, light forms of arthro-rheumatic diseases.
HOSPITAL FACILITY OF BALNEOLOGY, REHABILITATION
AND PROPHYLAXIS "KALEROYA" - HISSAR
Town of Hissar is a famous health resort, located at the foot of the Sredna Gora Mountains, established in the fifth millennium B.C. around the mineral springs by the Tracian tribe of Bessi. Hissar mineral waters have low level of mineralization, being hydrocarbonate-sulphate-sodium waters, containing a small amount of radon, fluoride, hyperthermal and moderately alkaline. They are recommended for the treatment of: kidney stones, chronic pyelonephritis, chronic cystitis and urethritis, post extracorporeal lithotrypsy state, single kidney, chronic renal failure - initial stage; chronic gastritis, gastro-duodenitis, functional gastric disorders, dyspepsia, chronic non-specific enterocolitis, peptic ulcer disease; gallstones, chronic cholecystitis; biliary dyskinesia, post viral hepatitis' states; metabolic syndrome, obesity, diabetes, gout, arthro-rheumatic diseases; inflammatory gynecological diseases; discopathy, radiculitis, polyneuritis.
HOSPITAL FACILITY OF BALNEOLOGY, REHABILITATION AND PROPHYLAXIS
"ST. GEORGE THE CONQUEROR" - POMORIE
The town of Pomorie is a talasso-, pelo- and climate-therapy resort, located upon a slightly elevated peninsular to the north end of Burgas gulf, established in the VI-V century B.C. The most precious treasure of the town is the world famous Pomorie healing mud, favourable for treatment of: arthrosis, arthritis, states post traumas and fractures; neuritis, radiculitis, disk herniation disease, pediatric cerebral palsy; sterility, dismenorrhea, ovarial hypofunction, parametritis; prostatitis, olygospermia, epididimitis, vesiculitis; psoriasis, psoriatic arthritis, hypothrophic skin lesions; bronchitis, sinusitis. In the hospital facilities a complex treatment is carried out with Pomorie mud, lye treatment, a rich scope of physiotherapeutic procedures, kinesitherapy, acupuncture, body building, aromatherapy, inhalation treatment, laser therapy, underwater jet massage, solarium, anticellulitis
program, sauna, thalassic therapy.
TOTAL NUMBER OF PATIENTS IN MILITARY MEDICAL ACADEMY
FOR 2003
IN-PATIENT CARE OUT-PATIENT CARE
35894 267062
Military Medical Academy is entitled with priority to provide emergency and immediate health care in the fields of the emergency medicine, radiology toxicology and infectious and parasitic diseases.
The Military Medical Academy operates in crisis situations through
Military Medical Detachment for Emergency Response (MMDER) including personnel of three of the hospital facilities of MMA: in Sofia, Plovdiv and
Varna.
PURPOSE: TO PROVIDE QUALIFIED AND PARTLY SPECIALIZED MEDICAL CARE IN THE EVENT OF NATURAL AND MAN-MADE DISASTERS IN PEACE TIME FOR MEETING THE MEDICAL NEEDS OF CIVIL POPULATION
SPECIFIC MILITARY UNITS FOR EMERGENCY RESPONSE
• 2 HELICOPTERS MI – 17
LIFTING CAPABILITY - 6 LITTERS
• 1 FIXED WING AIRCRAFT AN – 26
LIFTING CAPABILITY - 10 LITTERS + 10 SITTING PATIENTS
MMDC58 PERSONNEL
ROLE 2+
12 PERSONNELROLE 1
10 PERSONNELROLE 1
Disposition of personnel and levelsof medical care
IN CASE OF MASS CASUALTY SITUATIONS
MILITARY MEDICAL ACADEMY PROVIDES:
TEMPORARY CENTER FOR TREATMENT OF PATIENTS WITH ACUTE RADIATION SICKNESS;
TEMPORARY CENTER FOR TREATMENT OF INTOXICATED PATIENTS;
CENTER FOR TREATMENT OF INFECTIOUS AND PARASITIC DESEASES;
TEMPORARY TRAUMA CENTER.
As a recognition for good management, the MMA took an efficient management of five more medical facilities: two hospital facilities for continouous treatment and rehabilitation in Narechen and Velingrad, and three diagnostics and consultation centers in Haskovo, Stara Zagora and Burgass.
RUSSIA - JAPAN 1903-1905
W. W. I 1914-1918
W. W. II1941-1945
KOREA1952-1956
VIETNAM1956-1971
ALGERIA1962-1990
MOZAMBIQUE1978-1986
NICARAGUA1980-1981
SYRIA1980-1990
CAMBODIA1992-1993
BOSNIA AND HERZEGOVINA1997-CONTINUE
F.Y.R.O.MACEDONIA APRIL-JULY 1999
TURKEY 18-24 AUGUST 1999
KOSOVO2000- CONTINUE
AFGHANISTAN2002 - CONTINUE
ANGOLA1983
ETHIOPIA1978
LIBYA1979
LEBANONJULY-AUGUST 1981
ARMENIA 1989-1993
ROMANIA25-29 DECEMBER 1989
BULGARIAN MILITARY MEDICAL MISSIONS
Sofia
Black Sea
Romania
Serbia
Macedonia
Greece
Turkey
In conclusion we can state that the Health Care Reform in R. Bulgaria underwent successfully thanks to the integration of Civil and Military Healthcare System and especially Military Medical Academy thus decreasing the social and health price payed by the civilian population.
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