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.