Transcript Bulgarian Model.pps

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 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 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.
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.
MISSIONS
MILITARY MEDICAL
ACADEMY IS A MULTIPROFILE 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
MMA-MOD
MEDICAL FACILITIES FOR
OUT-PATIENT AND INPATIENT CARE
ADMINISTRATION
Research Center for
radiological, biological,
and chemical protection
Center for military
epidemiology and
hygiene
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
Rehabil Hospitals
- Hissar
- Pomorie
- Bankya
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
Troop medical units
Troop medical units
Medical Department
Navy HQ
Troop medical units
Central Depot
Lovech
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
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
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
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.
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 NorthEastern 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 NorthEastern region of Bulgaria, and an educational base for the
Medical University of Varna.
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.
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).
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
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 arthrorheumatic diseases.
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.
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
IN-PATIENT CARE
OUT-PATIENT
CARE
35894
267062
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
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-MAD
DISASTERS IN PEACE TIME FOR MEETIN
THE MEDICAL NEEDS OF CIVIL
POPULATION
SPECIFIC MILITARY UNITS FOR
EMERGENCY RESPONSE
• 2 HELICOPTERS MI – 17
LIFTING CAPABILITY - 6 LITTERS
• 1 FIXED WING AIRCRAFT AN – 26
LIFTING CAPABILITY - 10 LITTERS + 10
SITTING PATIENTS
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:
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.
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.
BULGARIAN MILITARY MEDICAL MISSIONS
RUSSIA - JAPAN
1903-1905
CAMBODIA
1992-1993
Romania
BOSNIA AND
HERZEGOVINA
1997-CONTINUE
W. W. I
1914-1918
W. W. II
1941-1945
Serbia
Black
Sea
KOREA
1952-1956
F.Y.R.O.MACEDONIA
APRIL-JULY 1999
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
SYRIA
1980-1990
ETHIOPIA
1978
LEBANON
JULY-AUGUST 1981
ARMENIA
1989-1993
ROMANIA
25-29 DECEMBER 1989
LIBYA
1979
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.