The bulgarian model of integrating military and civil health care system
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The Bulgarian Model of Integrating Military and Civil Health Care System. Lt.C. (R), Assoc. Prof. Kamen KANEV MD PhD, Brig. Gen. Prof. Stoyan TONEV MD PhD, Col. (R), Prof. Dimitar LEKOV MD PhD MILITARY MEDICAL ACADEMY, SOFIA, BULGARIA.

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The Bulgarian Model of Integrating Military and Civil Health Care System

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The bulgarian model of integrating military and civil health care system

The Bulgarian Model of Integrating Military and Civil Health Care System

Lt.C. (R), Assoc. Prof. Kamen KANEV

MD PhD,

Brig. Gen. Prof. Stoyan TONEV

MD PhD,

Col. (R), Prof. Dimitar LEKOV

MD PhD

MILITARY MEDICAL ACADEMY,

SOFIA, BULGARIA


The bulgarian model of integrating military and civil health care system

The reform of the Bulgarian Healthcare System has both a social and health price for the civilian population and major significance for the development of the Bulgarian military and civil medicine as a whole.


The bulgarian model of integrating military and civil health care system

The aim of this study is to investigate the integration of the Military and Civil Healthcare System while the Reform in the Health Care System takes place in order to diminish the negative social and health effects on the civil population.


The bulgarian model of integrating military and civil health care system

Under the conditions of reforming Civil Healthcare System, Military Healthcare System, especially Military Medical Academy resolves not only military medical tasks and problems in the country and abroad but opens its doors to the civilian population in the whole country.


The bulgarian model of integrating military and civil health care system

MISSIONS

MILITARY MEDICAL ACADEMY IS A MULTI-PROFILE MEDICAL FACILITY STRUCTURED TO PROVIDE BULGARIAN ARMED FORCES WITH UP-TO DATE MEDICAL CARE FOR THE SOLDIERS, AND TO ACT AS A PART OF THE NATIONAL HEALTHCARE SYSTEM

DECREE OF COUNCIL OF MINISTERS

#119/13.06.2002

GOALS

ACCOMPLISHMENT OF THE HEALTH REFORM IN MEDICAL SUPPORT IN ACCORDANCE WITH MILITARY DOCTRINE AND PLAN 2004

ACHIEVEMENT OF THE REQUIRED CAPABILITY TO PROVIDE MEDICAL SUPPORT TO THE FORCES ACCORDING TO NATO STANDARTS


The bulgarian model of integrating military and civil health care system

MMA-MOD

MEDICAL FACILITIES FOR OUT-PATIENT AND IN-PATIENT CARE

ADMINISTRATION

Departments, chairs, clinics, laboratories

- therapy

- surgery

-neurology, psychiatry,

neurosurgery

- image diagnosis

- laboratory

- emergency and intensive care

- healthcare operations

- disaster medicine

Center for military medical expertise and aviation medicine

Research Center for radiological, biological, and chemical protection

Rehabil Hospitals

- Hissar

- Pomorie

- Bankya

Center for military epidemiology and hygiene

MIL H - Plovdiv

Mil Med Det Em Res with branches

MIL H - Varna

MIL H - Sliven

MIL H - Pleven

Medical Department - GS

Medical Department Army HQ

Medical Department AF HQ

Medical Department Navy HQ

Central Depot Lovech

Troop medical units

Troop medical units

Troop medical units


Specific tasks

SPECIFIC TASKS

  • DIAGNOSIS, TREATMENT AND REHABILITATION FOR ALL WHO NEED MEDICAL CARE FROM THE ARMED FORCES AND CIVILIAN POPULATION

  • PROPHYLAXIS OF DISEASES AND INJURIES//PREVENTIVE MEDICINE SANITARY CONTROL ENVIR. CONTROL/

  • MEDICAL SUPPORT OF COMBAT TRAINING AND PHYSICAL TRAINING

  • MEDICAL EXPERTISE OF FITNESS FOR MILITARY SERVICE

  • SCIENTIFIC RESEARCH IN MILITARY MEDICINE

  • MILITARY MEDICAL TRAINING AND POSTGRADUATE MEDICAL TRAINING

  • READINESS FOR CRISIS RESPONSE OPERATIONS

  • MEDICAL SUPPORT OF MISSIONS ABROAD /INTEROPERABILITY WITH NATO COUNTRIES/

  • MEDICAL EVALUATION

  • MEDICAL LOGISTICS

  • ELABORATION OF MEDICAL KITS AND MODULES


Structure of mma

STRUCTURE OF MMA

  • MULTI-PROFILE HOSPITAL BASE FOR ACTIVE TREATMENT – SOFIA

  • HOSPITAL BASES FOR ACTIVE TREATMENT – VARNA, PLOVDIV, PLEVEN, SLIVEN

  • HOSPITAL BASES FOR BALNEOLOGY, REHABILITATION AND PROPHYLAXIS – HISSAR, POMORIE, BANKYA

  • CENTER FOR MILITARY MEDICAL EXPERTISE AND AVIATION MEDICINE

  • CENTER FOR MILITARY EPIDEMIOLOGY AND HYGIENE

  • RESEARCH CENTER FOR RADIOBIOLOGICAL, BIOLOGICAL AND CHEMICAL PROTECTION

  • MILITARY MEDICAL DETACHMENT FOR EMERGENCY RESPONSE / URGENT MILITAY MEDICAL UNIT/

  • TROOP MEDICAL UNITS


Personnel and number of beds

PERSONNEL and NUMBER OF BEDS

  • MEDICAL DOCTORS – 300

  • DENTISTS – 5

  • NURSES – 460

  • OTHER PERSONNEL – 555

  • PROFESSORS – 8

  • ASSOC. PROFESSORS – 44

  • ASSISTANT PROFESSORS – 38

  • DOCTORS OF SCIENSES – 10

  • DOCTORS - 64

  • MPHBAT -SOFIA 581

  • HBAT-PLOVDIV 120

  • HBAT-SLIVEN 100

  • HBAT-VARNA 280

  • HBAT PLEVEN 100

  • HBBRP-BANKYA 120

  • HBBRP-HISAR 215

  • HBBRP-POMORIE 150


The bulgarian model of integrating military and civil health care system

  • With its five hospital facilities for active treatment in Sofia, Plovdiv, Varna, Pleven, Sliven, as well as the hospital facilities for continuous treatment and rehabilitation in Bankya, Hissar and Pomorie, the Military Medical Academy provides highly qualified and specialty diagnostics, treatment, rehabilitation and prophylaxis of military and civilian patients in the entire country.


The bulgarian model of integrating military and civil health care system

HOSPITAL FACILITY FOR ACTIVE TREATMENT (HFAT) - VARNA

A hospital with 280 beds and a diagnostic-consulting block, providing full range of specialized medical services for the military contingent and the civil population of North-Eastern Bulgaria. At HFAT – Varna, there are established: Clinic of Internal Diseases, Department of Surgery, Clinic of Orthopedics and Traumatology, Clinic of Toxicology, Thermal Trauma Ward, ENT Ward and Ophthalmologic Ward. The excellent equipment and the high-qualified specialists allow HFAT – Varna to be a referral hospital for thermal trauma and intoxication treatment for the North-Eastern region of Bulgaria, and an educational base for the Medical University of Varna.


The bulgarian model of integrating military and civil health care system

HOSPITAL FACILITY FOR ACTIVE TREATMENT - PLOVDIV

The Hospital Facility for Active Treatment – Plovdiv is a health establishment with 100-years history and rich traditions in the structures of the Bulgarian Army. The health reform enabled the hospital to sign a contract with

the Health Insurance Fund and to render health care to all who wish. The hospital has an Admission-Consulting Block, where 8 functioning rooms (therapeutic, neurological, surgical, orthopedic, ENT, dental, and dermatological), diagnostic laboratories (Clinical Analyses Ward, Pathology Ward, Microbiological Laboratory), as well as Image Diagnostics Ward.The hospital has 120 beds in 8 clinic units: Internal Medicine Clinic, Clinic of Surgery, Clinic of Neurology and Psychiatry, ENT Ward, Dermatology and Venereal Diseases Ward, Ophthalmologic Ward and Physical Therapy Ward.HFAT - Plovdiv, as a branch of the Military Medical Academy-Sofia uses preferentially the diagnostic and therapeutic capacities of this leading healthcare establishment in the country – nuclear magnetic resonance imaging, computer tomograph scanner, lithotripter, hyperbaric chamber, etc.


The bulgarian model of integrating military and civil health care system

HOSPITAL FACILITY FOR ACTIVE TREATMENT (HFAT) - PLEVEN

HFAT is established in 1903 by a Decree of King Ferdinand as a Ninth Division Hospital for the purpose of medical provision of the army in Central North Bulgaria. This is a commitment the hospital has performed till present. The following units are functioning at HFAT - Pleven: diagnostic-consulting block and wards of surgery, internal diseases, neurology, physical therapy, anesthesiology and intensive care. Along with the regulatory assigned contingent, civilians may get healthcare at the hospital under the clinical pathways contracted with the Health Insurance Fund (asthma, diabetes, inguinal hernia, cardiac rhythm disorders, acute appendicitis, pneumonia, heart failure, chronic obstructive pulmonary disease, chronic diseases of tonsils).


The bulgarian model of integrating military and civil health care system

HOSPITAL FACILITY FOR ACTIVE TREATMENT (HFAT)- SLIVEN

Hospital Facility for Active Treatment in Sliven is integrated part of the MMA, providing healthcare to the military contingent of Southeastern Bulgaria.It has Diagnostic Consulting Block including: X-ray ward, Functional Diagnostics, Laboratory and Consulting-Reception Rooms. The Stationary Block has 100 beds in 12 wards: Surgery, Emergency and Septic Surgery, Urology, General Therapy, Cardiology, ENT, Anesthesiology Reanimation and Intensive Care Unit, Infectious Diseases, Physiotherapy and Pathology.Civilians have the right to be treated in HFAT - Sliven under the 23 clinical pathways contracted with the Health Insurance Fund


The bulgarian model of integrating military and civil health care system

HOSPITAL FACILITY OF BALNEOLOGY, REHABILITATION AND PROPHYLAXIS – BANKYA

The major sanative factors of the town of Bankya are the mineral waters (hydrothermal, hydrocarbonate-sulphate-sodium, silicon and lightly fluorized) and the climate (moderate continental with foot-of-mountain influence).

The hospital facility of Bankya is specialized in treatment and rehabilitation of cardio-vascular and brain diseases and post-surgery conditions: valvular heart diseases with heart failure up to 1st degree; cardiac defect post-surgery conditions; ischemic heart disease; conditions following myocardial infarction, compensated forms of myocardial dystrophy, 1-2 stage hypertension disease; atherosclerosis in early stage, angioneurosis and 1-2 stage Raynaud's disease; 1-2 stage Burger's disease; atherosclerotic arterial obliteration of extremities - up to the 2 stage; functional disorders of nervous system.A favorable influence is observed in some light forms of thyreotoxicosis, light forms of diabetes, obesity, chronic neuralgia and neuritis, chronic gastritis and colitis, light forms of arthro-rheumatic diseases.


The bulgarian model of integrating military and civil health care system

HOSPITAL FACILITY OF BALNEOLOGY, REHABILITATION AND PROPHYLAXIS "KALEROYA" - HISSAR

Town of Hissar is a famous health resort, located at the foot of the Sredna Gora Mountains, established in the fifth millennium B.C. around the mineral springs by the Tracian tribe of Bessi. Hissar mineral waters have low level of mineralization, being hydrocarbonate-sulphate-sodium waters, containing a small amount of radon, fluoride, hyperthermal and moderately alkaline. They are recommended for the treatment of: kidney stones, chronic pyelonephritis, chronic cystitis and urethritis, post extracorporeal lithotrypsy state, single kidney, chronic renal failure - initial stage; chronic gastritis, gastro-duodenitis, functional gastric disorders, dyspepsia, chronic non-specific enterocolitis, peptic ulcer disease; gallstones, chronic cholecystitis; biliary dyskinesia, post viral hepatitis' states; metabolic syndrome, obesity, diabetes, gout, arthro-rheumatic diseases; inflammatory gynecological diseases; discopathy, radiculitis, polyneuritis.


The bulgarian model of integrating military and civil health care system

HOSPITAL FACILITY OF BALNEOLOGY, REHABILITATION AND PROPHYLAXIS "ST. GEORGE THE CONQUEROR" -POMORIE

The town of Pomorie is a talasso-, pelo- and climate-therapy resort, located upon a slightly elevated peninsular to the north end of Burgas gulf, established in the VI-V century B.C. The most precious treasure of the town is the world famous Pomorie healing mud, favourable for treatment of: arthrosis, arthritis, states post traumas and fractures; neuritis, radiculitis, disk herniation disease, pediatric cerebral palsy; sterility, dismenorrhea, ovarial hypofunction, parametritis; prostatitis, olygospermia, epididimitis, vesiculitis; psoriasis, psoriatic arthritis, hypothrophic skin lesions; bronchitis, sinusitis.

In the hospital facilities a complex treatment is carried out with Pomorie mud, lye treatment, a rich scope of physiotherapeutic procedures, kinesitherapy, acupuncture, body building, aromatherapy, inhalation treatment, laser therapy, underwater jet massage, solarium, anticellulitis program, sauna, thalassic therapy.


Total number of patients in military medical academy for 2003

TOTAL NUMBER OF PATIENTS IN MILITARY MEDICAL ACADEMY FOR 2003


The bulgarian model of integrating military and civil health care system

Military Medical Academy is entitled with priority to provide emergency and immediate health care in the fields of the emergency medicine, radiology toxicology and infectious and parasitic diseases.


The military medical academy operates in crisis situations through

The Military Medical Academy operates in crisis situations through

Military Medical Detachment for Emergency Response (MMDER) including personnel of three of the hospital facilities of MMA: in Sofia, Plovdiv and Varna.

PURPOSE: TO PROVIDE QUALIFIED AND PARTLY SPECIALIZED MEDICAL CARE IN THE EVENT OF NATURAL AND MAN-MADE DISASTERS IN PEACE TIME FOR MEETING THE MEDICAL NEEDS OF CIVIL POPULATION


Specific military units for emergency response

SPECIFIC MILITARY UNITS FOR EMERGENCY RESPONSE

  • 2 HELICOPTERSMI – 17

    LIFTING CAPABILITY- 6 LITTERS

  • 1 FIXED WING AIRCRAFT AN – 26

    LIFTING CAPABILITY- 10 LITTERS + 10 SITTING PATIENTS


The bulgarian model of integrating military and civil health care system

Disposition of personnel and levels

of medical care

10 PERSONNEL

ROLE 1

MMDC

58 PERSONNEL

ROLE 2+

12 PERSONNEL

ROLE 1


In case of mass casualty situations military medical academy provides

IN CASE OF MASS CASUALTY SITUATIONS MILITARY MEDICAL ACADEMY PROVIDES:

TEMPORARY CENTER FOR TREATMENT OF PATIENTS WITH ACUTE RADIATION SICKNESS;

TEMPORARY CENTER FOR TREATMENT OF INTOXICATED PATIENTS;

CENTER FOR TREATMENT OF INFECTIOUS AND PARASITIC DESEASES;

TEMPORARY TRAUMA CENTER.


The bulgarian model of integrating military and civil health care system

As a recognition for good management, the MMA took an efficient management of five more medical facilities: two hospital facilities for continouous treatment and rehabilitation in Narechen and Velingrad, and three diagnostics and consultation centers in Haskovo, Stara Zagora and Burgass.


The bulgarian model of integrating military and civil health care system

BULGARIAN MILITARY MEDICAL MISSIONS

RUSSIA - JAPAN

1903-1905

CAMBODIA

1992-1993

Romania

W. W. I

1914-1918

BOSNIA AND

HERZEGOVINA

1997-CONTINUE

W. W. II

1941-1945

F.Y.R.O.MACEDONIA

APRIL-JULY1999

Serbia

Black

Sea

KOREA

1952-1956

TURKEY

18-24 AUGUST 1999

Sofia

VIETNAM

1956-1971

KOSOVO

2000- CONTINUE

ALGERIA

1962-1990

AFGHANISTAN

2002 - CONTINUE

Macedonia

Turkey

MOZAMBIQUE

1978-1986

ANGOLA

1983

Greece

NICARAGUA

1980-1981

ETHIOPIA

1978

SYRIA

1980-1990

LEBANON

JULY-AUGUST 1981

ARMENIA

1989-1993

ROMANIA

25-29 DECEMBER 1989

LIBYA

1979


The bulgarian model of integrating military and civil health care system

In conclusion we can state that the Health Care Reform in R. Bulgaria underwent successfully thanks to the integration of Civil and Military Healthcare System and especially Military Medical Academy thus decreasing the social and health price payed by the civilian population.


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