Résumé :
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The Bulgarian health system remained on the periphery of the country's public sector reforms until the late 1990s. The system appeared to be maintaining itself and there were other political priorities, given the catastrophic state of the Bulgarian economy. Numerous changes of government and lack of political will for radical reforms meant that little changed until 1997, when the imminent collapse of the health system became obvious. The population was overloaded with unregulated payments and a black market for health care services had started to appear. A step-by-step approach to reform was adopted during the years of economic crisis. The ministry of Health adopted a strategy for reform based on the principles of equity, cost-effectiveness and quality of care. An increasing volume of information had been collected since 1992 and much technical and financial help was received from international donors. Staff are being trained to manage these reforms. The general principles, and the philosophy of previously unfamiliar concepts like general medicine, health insurance, health promotion and family planning, have now made major advances in the health system.
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