Medical specialists on “Health cares” and specialists graduated from medical colleges in health establishments as of 31.12. by statistical regions and districts

National Statistical Institute

"Health and Justice Statistics" Department

Evelin Yordanova

Head of department

2, P. Volov Str.; 1038 Sofia, Bulgaria

[email protected]

+359 2 9857 459

National and regional data about medical personnel - physicians, dentists, health care professionals and other medical specialists, by specialties are presented. The survey methodology is in accordance with the Regulation (EU) 2022/2294 of the Commission as regards statistics on healthcare facilities, healthcare human resources and healthcare utilisation. Тhe guidelines and definitions of the practicing medical specialists are aplied.

· Nomenclature of physicians by specialties in accordance with the Ordinance № 1 of 22 January 2015 of the Ministry of Health (amended and supplemented, SG No. 51 of 13 June 2023);

· Classification of Territorial Units for Statistical Purposes in Bulgaria (NUTS).

 The data on medical personnel includes the number of all practicing personnel (head counts) who worked on a basic labour contract in health establishments, regardless of their ownership and subordination, individual and group practices for primary and specialised medical care and dental care as well as the medical personnel who worked in schools and creches, from 2022 outpatient establishments for individual and group healthcare practices are included in the number on medical personnel.. Data for medical personnel attached to other ministries is not included in the distribution by districts.

Data on medical specialists working outside of the country as well as on medical specialists practicing outside of the health establishments (for example, doctors working for pharmaceutical industry) are excluded.

Practicing physicians provide services directly to patients. Practicing physicians' tasks include: conducting medical examination and making diagnosis, prescribing medication and giving treatment for diagnosed illnesses, disorders or injuries, giving specialized medical or surgical treatment for particular types of illnesses, disorders or injuries, giving advice on and applying preventive medicine methods and treatments. Inclusion: persons who have completed studies in medicine at university level (granted by adequate diploma) and who are licensed to practice; interns and resident physicians (with adequate diploma and providing services under supervision of other medical doctors during their postgraduate internship in a health care facility); salaried and self-employed physicians delivering services irrespectively of the place of service provision; foreign physicians licensed to practice and actively practicing in the country.

Practicing dentists provide services directly to patients. Practicing dentists' tasks include: making diagnosis, advising on and giving necessary dental treatment, giving surgical, medical and other forms of treatment for particular types of dental and oral diseases and disorders. Inclusion: persons who have completed studies in dentistry / stomatology at university level (granted by an adequate diploma) and who are licensed to practice; interns (with an adequate diploma and providing services under supervision of other dentists or dental specialists during their postgraduate internship in a health care facility); salaried and self-employed dentists delivering services irrespectively of the place of service provision; foreign dentists licensed to practice and actively practicing in the country.

Data on students who have not yet graduated; physicians and dentists working in administration, research and in other posts that exclude direct contact with the patients; unemployed physicians and retired physicians as well as on physicians working abroad are excluded from the number of practicing physicians and dentists.

The distribution of the physicians by specialties is based on the national nomenclature in accordance with the Ordinance No 1 of the Ministry of Health (SG, 7/2015). The distribution by specialties is assign to the physicians' practicing specialty.

Indicators on the population per one physician and per one dentist are calculated based on the number of the population at the end of the year. The number and structure of the population at the end of each year are calculated on the basis of the previous year's data and the data on natural movements and migration of the population in the current year. The population estimate as of 31 December 2022 reflects the changes in population numbers and structure recorded in the Census 2021. In this regard, there is a break in the time series for all coefficients for 2022.

Statistical units are medical practicing specialists, who works on a basic labour contract. Reporting units are health establishments, crèches or groups in kindergartens.

All medical specialists who worked on a basic labour contract in health establishments, covered by the survey - all in-patient (hospitals and centres with beds), outpatient health establishments - medical centres, dental centres, medical-dental centres, diagnostic and consulting centres, medical-diagnostical and medical-technical laboratories, individual and group healthcare practices (from 2022) and other health establishments are covered. Data source for the individual and group practices for primary and specialised medical and dental care is the National Health Insurance Fund.

Other health establishments include centres for urgent medical aid, centres for transfusion haematology, hospices, medical universities and colleges, municipalities (for the medical personnel in schools), national centres without beds, regional health inspections, homes for medico-social care for children, tissues banks and integrated care centres for children with disabilities and chronic illnesses.

The whole territory of the Republic of Bulgaria is covered. The regional data is according to administrative-territorial division of the country at 31.12. relevant year.

2001 - 2023

Not applicable.

Number

31.12. of the reference year

· Regulation (EC) No 1338/2008 of the European Parliament and of Council of 16 December 2008 on Community statistics on public health and health and safety at work;

· Regulation (EU) 2022/2294 of the Commission as regards statistics on healthcare facilities, healthcare human resources and healthcare utilisation;

· Law on Statistics;

· Law on Health;

· Ordinance № 1/27.02.2013 of the Minister of Health for the provision of medico-statistical information and information on health establishments medical activities;

· Ordinance № 1 of 22 January 2015 of the Ministry of Health (amended and supplemented, SG No. 51 of 13 June 2023).

Since 2010, Eurostat, the Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO) started procedure of joint data collecting on non-monetary health care statistics (health care activities).

· Law on Statistics;

· Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society.

Individual data are not published in accordance with article 25 of the Law on Statistics. The publishing of individual data can be performed only in accordance with article 26 of the same law.

The date of the statistical information release is shown in the Release Calendar presenting the results of the statistical surveys carried out by the National Statistical Institute.

The calendar is available on the NSI website: https://www.nsi.bg/en/node/480

Data on Medical personnel is published on the NSI website, section Health in accordance with the Law on Statistics and the European Statistics Code of Practice respecting the professional independence and aimed at objectivity, transparency and equal treatment of all consumers.

Annually

Annual press release.

· Health Services;

· Statistical Yearbook;

· Statistical Reference Book;

· Brochure "Bulgaria";

· Regions, Districts and Municipalities in Bulgaria.

Data on Medical personnel are available to all users of the NSI website under the heading Health - In-patient, out-patient and other health care establishments - Medical personnel: https://www.nsi.bg/en/node/5582

Online database of Eurostat:

https://ec.europa.eu/eurostat/web/main/data/database

Not applicable.

Information service on request, according to the Rules for the dissemination of statistical products and services in NSI.

· Healthcare non-expenditure statistics manual and Guidelines for completing the Joint questionnaire on non-monetary healthcare statistics (2023 edition);

· Methodological notes;

Not available.

The completed online forms are validated at the regional level by the Regional Health Inspections, and the reporting forms submitted on paper are collected and entered by the same experts, which guarantees the full scope and quality of the data received.

Integrated quality and security management system has been implemented in accordance with the requirements of BDS EN ISO 9001: 2015 and BDS EN ISO 27001: 2017. The certificate fully meets all international requirements and guarantees the quality of the processes and information security of the entire statistical and information infrastructure of the NSI, both at national and regional levels.

Data on main non-monetary indicators on health care statistics (health care activities) are provided annually to Eurostat, World Health Organization (WHO) and Organisation for Economic Co-operation and Development (OECD) via joint annual questionnaire filled-in in strict compliance with the prescribed terms and forms of presentation of the data in accordance with the Regulation (EU) 2022/2294. Through annual questionnaires data are also provided to other European and international organizations.

The data are provided annually to National Centre for Public Health and Analysis, Ministry of Health and its territorial units - Regional Health Inspections, whose functions are to formulate policies in the field of health care at national and regional level.

Data users of health information at national and regional level.are the National Assembly of the Republic of Bulgaria, the executive and local authorities, National Health Insurance Fund, NGOs,

Upon request, data is provided to research institutes, universities, NGOs and other users in conformity with the rules established in NSI.

Not applicable.

Data are еxhaustive.

Exhaustive survey.

Not applicable.

Not applicable.

T+6 months

Data are disseminated according to the Release Calendar presenting the results of the statistical surveys carried out by the National Statistical Institute.

When data at regional level has been compared, it should be noted that the health establishments are not directly connected to the servicing of population of a given settlement or even of municipality. A great part of health establishments serve the population of a given district or a group of municipalities, and the specialized health care establishments - oncological, dermato-venereological, psychiatric, pulmonary and other service the population of 2 or 3 districts.The establishments under central administration, regardless of their location, serve the population from the whole country.

Data are comparable at all territorial levels in the country for the periods 2001-2009 and 2010-2023.

2010 – break in time series in respect to the territorial distribution of physicians and dentists as well as distribution of physicians by practiced specialty. Since 2018, there is a change of the methodology in respect to the counting of practicing physicians and dentists. The changes have been made in order to avoid double counting and to increase the quality of information. In this regard, and to ensure comparability, the data for the period 2010-2017 have been revised as follows:

- medical practitioners working in practices that serve more than one municipality or district are included in the total number but not distributed by municipalities or by district;

- physicians working in specialized practices under a contract with the NHIF are allocated to the specialty they are practiced. Those who practice more than one specialty are included in the total but not allocated by specialty.

The methodological amendments has been made in order to avoid double counting and to increase the quality of information.

Data are comparable for the periods 2001-2009 and 2010-2023.

2010 – break in time series in respect to the territorial distribution of physicians and dentists as well as distribution of physicians by practiced specialty.

For all coefficients, the data are comparable to 2021.

There is a break in the time series for all coefficients for 2022. The indicators per 10 000 of the populationq are calculated based on data on total population as of the end of the year.

The number and structure of the population at the end of each year are calculated on the basis of the previous year's data and the data on natural movements and migration of the population in the current year. The population estimate as of 31 December 2022 reflects the changes in population numbers and structure recorded in the Census 2021. In this regard, there is a break in the time series for all coefficients for 2022.

Not applicable.

Not applicable.

Not applicable.

It is possible to revise the data in case of change of the methodology or the applied methods of the survey, as well as in case of change of the applied classifications and nomenclatures.

2010-2017 data have been revised as follows:

- medical practitioners working in practices that serve more than one municipality or district are included in the total number but not distributed by municipalities or by district;

- physicians working in specialized practices under a contract with the NHIF are allocated to the specialty they are practiced. Those who practice more than one specialty are included in the total but not allocated by specialty.

Data source about medical personnel is the reporting form filled in by health establishments, municipalities (for the medical personnel in schools and кindergartens), crèches or Homes for medico-social care.

Data source in respect to the number of physicians and dentists in individual and group practices for primary and specialised medical care is the National Health Insurance Fund.

Annually

The process of collection of reporting forms is carried out by NSI and Regional Health Inspections. Data entry is carried online by the respondents or by the RHIs (for paper documents).

Data on hospital beds are validated with those from the specialized survey on the activity of the health establishments, conducted by the National Center for Public Health and Analysis.

The statistical data on practicing medical specialists and the application of statistical guidelines are validated yearly by Eurostat/WHO/OECD experts.

Data entry is carried online by the respondents or by the RHIs (for paper documents).

The data is consolidated at national level by adding information from the surveys carried out by the NSI 'Homes for medico-social care for children' and 'Crèches'. Data on practicing physicians and dentists in individual and group practices for primary and specialised medical care are added as well. 

The information on medical personnel in health establishments attached to other ministries is added at national level.

Not applicable.