Clinical pathways - a retrospective view on their application as a financial tool in Bulgarian hospitals.

Abstract Introduction During 2000-2001, CPs were developed and implemented as a temporary solution for financing the hospitals in Bulgaria. The aim of this article is to study and trace the application of clinical pathways as a tool for hospital funding in Bulgaria. Material and methods In order to examine the implementation and the progress of CPs in Bulgarian hospitals we have studied Bulgarian and foreign publications. In addition to this, we also include official reports published by the Ministry of Health, Ministry of Finance, National Health Insurance Fund (NHIF), The National Center of Public Health and Analyses (NCPHA) and others. Results and discussion For the first time, CPs are negotiated and included in the National Framework Contract in 2001. Gradually, the number of CPs increased and reached more than 300 in 2015. The introduction of CPs as a tool for financing the hospital care is related to the need of fixing the prices of the respective CPs. Initially, the NHIF and the Bulgarian Medical Association developed a common methodology for fixing the prices of CPs. Since 2011, an amendment to the Health Insurance Act stipulates that the procedures for valuation and payment of activities by NHIF are defined by explicit methodologies. We have found that not all hospitals submit information to the specialized software for hospitals which is the only tool for analyzing the costs structure in the health care establishments at present. Conclusion The clinical pathways are not accepted as a sufficient effective mechanism for hospital funding in Bulgaria. Moreover, the lack of accurate and comparable information makes the analyses incomplete and vulnerable.