There is only one key theme describing market access for medical technologies in Bulgaria:
- Reimbursement: payment mechanism via the case-payment categories and add-on reimbursement via List of medical devices
There is no stand-alone health technology assessment process for medical technologies in Bulgaria.
Hospital care is reimbursed via case-payment categories, which are lump sum payments for the entire episode of care. Three types of case-payment categories exist:
- Clinical pathways (KPs, for hospital stays of more than 48h)
- Clinical procedures (KPrs, for services requiring admission for up to 24h)
- Ambulatory procedures (APrs, for services not requiring admission).
In addition, certain medical devices are included in the List of medical devices that are paid on top of the case payment.
Procedures are coded using the Medical Procedure Coding System (KSMP), which is based on the Australian Classification of Health Interventions (ACHI). KSMP system is maintained by the National Center of Public Health and Analyses, and has had only one update since its introduction. Currently, the KSMP is used parallelly with the outdated ICD-9-CM classification, which will gradually be fully replaced. The replacement can be considered as a first step towards the implementation of the DRG system.
Specifics for IVD tests
In-vitro diagnostic tests in ambulatory settings are reimbursed via a fee-for-serivce model using a basic benefit package, supervised by the National Health Insurance Fund.
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