Economic thought
Articles

METHODS FOR QUALITY IMPROVEMENT OF MEDICAL SERVICES IN BULGARIA

Petko Salchev — National Center of Public Health and Analyses
Boyan Likomanov — Senior HTA expert at HTA Ltd., Bulgaria
Ivelina Yankova — HTA Expert at HTA Ltd.
Adriana Dacheva — PhD, is а Partner and operations director at HTA Ltd.
Veneta Todorova — PhD, is а team lead at HTA Ltd.
Toni Vekov — Professor at the Heart and Brain Scientific Organization
Slaveyko Djambazov — PhD, is а founder and managing partner at HTA Ltd.

Abstract

The quality of medical services is a key indicator of the health system’s success. Traditionally, it has been assessed through the accessibility and effectiveness of services provided. However, modern approaches emphasising the real impact on patient health measure it through health outcomes (clinical, CROMs, patient-reported outcomes, PROs). This shift from process-oriented to outcome-oriented models is at the heart of the concept of patient-centred healthcare. Outcome-oriented approaches are a key element in improving the quality of healthcare services. Patient-centred healthcare shifts the focus from quantitative indicators to the real impact on health, combining clinical outcomes and cost-effectiveness. By implementing strategic measurements and incentives to improve outcomes, health systems can deliver better added value for patients and contribute to sustainable development in the sector.

References

Dang, A. (2023). Real-World Evidence: A Primer. Pharmaceut Med., 37 (1), 25. Available at https://pmc.ncbi.nlm.nih.gov/articles/PMC9815890/ (last access 2025, March 10).

FDA. Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims. Available at https://www.fda.gov/regulatory-information/search-fda-guidance-documents/patient-reported-outcome-measures-use-medical-product-development-support-labeling-claims

Gibson Parrish, R. (2010). Cdc for. Measuring Population Health Outcomes. Prev. Chronic Dis., 7 (4), A71. Available at https://pmc.ncbi.nlm.nih.gov/articles/PMC2901569/ (last access 2025, April 1).

Kaplan, R. S., Bower, M. (2018). Overcoming the Barriers to Implementing Value-Based Health Care. Harvard Business Scool. Available at https://oralhealth.hsdm.harvard.edu/files/oralhealth/files/bob_kaplan.pdf

McKinsey (2018). Real-world evidence: From activity to impact in healthcare decision making. Available at https://www.mckinsey.com/industries/life-sciences/our-insights/real-world-evidence-from-activity-to-impact-in-healthcare-decision-making (last access 2025, March 10).

NEJM Catalyst. (2025). What Is Value-Based Healthcare? Available at https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0558

New Cancer Bundle from CMS: the Enhancing Oncology Model. Available at https://www.urotoday.com/library-resources/health-policy/145595-new-cancer-bundle-from-cms-the-enhancing-oncology-model.html (last access 2025, March 11).

Salchev, P., Dimitrov, Pl., Vekov, T., Dzhambazov, S. (2018). Rakovodstvo za otsenka na zdravnite tehnologii. Sofiya: NTSOZA. [Салчев, П., Димитров, Пл., Веков, Т., Джамбазов, С. (2018). Ръководство за оценка на здравните технологии. София: НЦОЗА] (in Bulgarian).

Teisberg, E., Wallace, S., O’Hara, S. (2019). Defining and Implementing Value-Based Health Care: A Strategic Framework. Acad. Med., 95 (5), 682–685. Available at https://pmc.ncbi.nlm.nih.gov/articles/PMC7185050/ (last access 2025, April 1).