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Bulgaria

2012: National Dementia Strategies (diagnosis, treatment and research)

Background information about the National Dementia Strategy

Status and historical development of the National Dementia Strategy

There is currently no National Dementia Strategy in Bulgaria.

Involvement of the Alzheimer association (and/or people with dementia)

Discussions are underway about the need for a National Dementia Strategy in Bulgaria and a model is being prepared to facilitate the development of such a strategy. A three-day roundtable was planned for the end of September in order to exchange experience and expertise in connection with the development of a National Strategy for dementia. Representatives from the Czech Republic and Macedonia were invited to the September round-table discussions. The executive authorities in Bulgaria /Ministry of Labour and Social Policy confirmed their participation but the Ministry of Health and Ministry of Finance did not appoint people to participate. This meeting was postponed and is now scheduled for the end of November 2012.

Diagnosis, treatment and research

Issues related to timely diagnosis

There are no measures at national level but Alzheimer Bulgaria Association is working to improve awareness and understanding of dementia.

Which healthcare professionals are responsible for diagnosing dementia

Whilst GPs are expected to recognise symptoms which might suggest dementia, their role is to refer people with suspected dementia to a specialist in diagnosis. In practice, in many places in the country doctors do not recognise the symptoms of dementia.

Neurologists and psychiatrists can also diagnose dementia and/or Alzheimer’s disease. However, people usually only go to see a specialist when they are in the final stage of dementia.

GPs do not have a set consultation time. However, they are paid for consultations of 10 minutes regardless of the patient’s age or diagnosis. Elderly patients and those with dementia are not given any extra time. There is no incentive for GPs to have longer consultation times as they would not receive additional payment for the extra time spent with the patient.  

There are no incentives for GPs to improve or increase timely diagnosis.

Type and degree of training of GPs in dementia

In their professional training to become a GP, GPs have one module on neurology.  The entire module on neurology lasts three months and incorporates two days’ training in dementia. GPs are not under any obligation to take part in further courses or training once qualified.

Required tests to diagnose dementia

The MMSE test is generally used to diagnose dementia but its use is not obligatory and not all general practitioners are familiar with it or use it. There is no organised system for early diagnosis. The MMSE test is not included in the preventive work of GPs. Diagnosis is concentrated only in big cities with medical universities such as in Sofia, Plovdiv, Varna and Pleven. Specialists are obliged to administer certain tests in order to make a correct diagnosis. However, the equipment that they would need for this is only available in university hospitals.

Issues related to medical treatment

The availability of medicines in general

During the Communist government, the production and distribution of pharmaceutical drugs were the responsibility of the State. There has since been a transition to a market economy, whereby state-owned companies produce and distribute pharmaceuticals (Koulaksazov et al., 2003). Some have been privatised (Compassion Alzheimer Bulgaria, 2007).

The compulsory health insurance, which was introduced by the Health Insurance Act of 1998, gives people the right to certain medical treatment and drugs. The compulsory health insurance contribution is 8% of a person’s income. It is divided between the employer and employee in the ratio of 60:40. The contributions are mandatory and are not linked to the expected cost of care.

Most drugs have to be purchased by individuals at market prices. However, certain drugs are partly or totally reimbursed by the National Health Insurance Fund (NHIF). A list of diseases for which drug treatment is reimbursable is drawn up by the NHIF taking into account principles accepted in the EU and recommendations made by the World Health Organisation. This list tends to include diseases which have a considerable social impact and those which are classed as a national health priority. In order to be refunded, a drug must:

- have marketing authorisation from the Bulgarian Drug Agency;

- be for the treatment of a disease which is included in the official list of diseases;

- be provided on prescription (by a specialist for certain diseases);

- not contain more than two active substances.

For drugs that are refunded, there are nevertheless three levels of reimbursement: 

- 100 % for drugs that are linked to diseases covered by the National Health Strategy (e.g. for severe and chronic illnesses),

- 75 % for drugs of proven therapeutic efficacy for diseases not covered by the National Health Strategy (but with a social impact as defined by the Ministry of Health).

- 50 % for all other drugs.

If refundable by the NHIF, this takes the form of a fixed amount which is deducted from the retail price. The patient must pay the difference.

Source of the above information on reimbursement: Datzova, 2003

The availability of Alzheimer treatments

All AD drugs are available in Bulgaria but Memantine is available under the name "Axura".

Conditions surrounding the prescription and reimbursement of AD drugs

None of the AD drugs are amongst the drugs that are refunded. People with dementia therefore need to cover these costs themselves. However, since 2010 Aricept and Exelon have been refunded by the State if used during hospital treatment.

As a result of the long-term initiatives of Alzheimer Bulgaria Association, Alzheimer's disease is currently included in the list of diseases in Ordinance № 38 which determines the diseases for which the National Health Insurance Fund pays, either wholly or partially, for home treatment, drugs, medical devices and dietary foods for special medical purposes. However, the drugs for the home treatment of people with Alzheimer's disease are not reimbursed and patients have to pay for all the drugs themselves. The Bulgarian Alzheimer Association is pursuing this issue.

Prescription and reimbursement

Donepezil

Rivastigmine

Galantamine

Memantine (Axura)

Available

Yes

Yes

Yes

Yes

Reimbursed

No

No

No

 No

Drug reimbursed if initially prescribed by

N/A

N/A

N/A

 N/A

Continuing treatment reimbursed if prescribed by

N/A

N/A

N/A

N/A

Required examinations

None

None

None

None

MMSE limits

N/A

N/A

N/A

N/A

Issues related to research

Bulgaria is not involved in the EU Joint Programme – Neurodegenerative Disease Research (JPND) or the Joint Action “Alzheimer Cooperative Valuation in Europe (ALCOVE)”.

References

To add

Acknowledgements

Irina Vasileva Ilieva, Alzheimer Bulgaria Association

Lora Ivanova, Legal Advisor

 

 
 

Last Updated: Tuesday 14 May 2013

 

 
  • Acknowledgements

    The above information was published in the 2012 Dementia in Europe Yearbook as part of Alzheimer Europe's 2012 Work Plan which received funding from the European Union in the framework of the Health Programme. Alzheimer Europe gratefully acknowledges the support it has received from the Alzheimer Europe Foundation for the preparation and publication of its 2012 Yearbook.
  • European Union
 
 

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