Access to doctors: modest improvement for GPs in some districts
Despite the COVID-19 pandemic and the measures taken to support the healthcare system, the problems it faces are far from resolved. One of the significant obstacles to the proper functioning of the system is the availability of healthcare professionals, which has deteriorated in recent years.
For the "Regional Profiles: Development Indicators" project, the team at the Institute for Market Economics (IME) developed an index that assesses access to specialist doctors in different regions of the country. The index is based on data on the territorial distribution of 17 groups of specialist doctors as of the end of 2020, measured by the number of doctors of each specific specialty per population. The access assessment for each group in the individual regions represents the distance from the region with the widest access to doctors of that specific specialty, while the overall accessibility index (presented in Figure 1) represents the average value of the assessments for the individual regions.
Figure 1: Accessibility Index of Specialist Doctors by Regions in 2019-2021, lower is better
Source: National Statistical Institute (NSI), calculations by IME
According to the IME index in 2021, access to specialist doctors remains the easiest in Pleven. This can largely be explained by the presence of a large medical university in the regional center, while the region is not among the most populous. As expected, the capital city ranks second with its large number of specialized medical institutions. Similar access is observed in Plovdiv and Varna, while Sofia-Oblast also ranks among the top five. Outside of the leading regions, most regions have relatively similar index values. The most challenging access is evident in Dobrich, Kardzhali, and Yambol. Most regions share similar problems with access, most commonly observed in cardiology, obstetrics-gynecology, and psychiatry. Compared to the previous year, access to specialized doctors has worsened in most regions (a lower index value is better) compared to the previous year. Exceptions are Pleven, Vidin, Kyustendil, Lovech, and Yambol, where improvements are visible, but they are most prominent in Pleven. It is noteworthy that some of the largest cities, including the capital, Plovdiv, and Varna, have experienced a decline in the index over the past year, likely reflecting the opposite dynamics of doctor concentration due to the treatment of COVID-19. In 2021, access to specialists deteriorated most rapidly in Razgrad and Kardzhali.
Figure 2: Accessibility Index of Specialist Doctors by Specialties in 2019-2021, lower is better
Source: NSI, calculations by IME
Among the individual specialties, the smallest regional differences in access are observed among infectious disease specialists. However, this is primarily due to their small number – a total of 248 in the entire country, with only 39 in the capital and two in several regions. On the contrary, the most uneven distribution is found among the most common specialists. Out of 1,843 cardiologists, nearly five hundred are located in Sofia, while only 12 operate in the entire Targovishte region. Similar distribution patterns can be observed among obstetrician-gynecologists. An explanation for the differences in specialties may also be the varying workload of individual specialists, although this remains speculative due to the lack of available data. The distribution of hospital facilities, their prestige, and payment capabilities, as well as other factors, are also significant. In many specialties, a decline in the overall access index is observed in 2021, with the most notable trends seen among laboratory doctors, obstetrician-gynecologists, and neurologists. Conversely, access to ophthalmologists and internal medicine experts is improving rapidly.
Figure 3: Population per General Practitioner in the Regions, 2019-2022
Source: National Statistical Institute (NSI), calculations by IME
However, one can see a reversal of the trend among general practitioners, with improvements in access evident in several regions for the first time in a decade. The trend towards improving access is visible in some parts of the country, including those experiencing the greatest difficulties - Targovishte (+102 people per GP) and Silistra (+95 people per GP). Part of the explanation for the improvement of the indicator in some regions is also related to demographic processes and population decline. On the other hand, the most noticeable negative change occurs in Burgas, with 71 people per GP, as well as in Haskovo and Pernik. At this stage, it is too early to speak of a long-term trend toward improving access, as we are observing improvements within a one-year timeframe.
Significant differences between regions are also present, with Pleven once again being the leader with 1214 people per GP, while Kardzhali performs the weakest, with over 3 thousand people per GP. It is also noteworthy that the leading economic centers - Varna, Plovdiv, and the capital - are concentrated in the middle of the distribution, most likely due to population growth.
However, it should be noted that the data on access to doctors do not provide the complete picture of the quality of regional healthcare systems. Many other factors - from the available equipment in hospitals to the workload and qualification of individual doctors - determine how well they will manage patient treatment. Nevertheless, the deterioration in access to doctors, both specialists and general practitioners, is inevitably a sign of negative developments in the healthcare system.
