Comparative analysis of the Bulgarian and Norwegian health care systems

Abstract

BACKGROUND: Bulgaria and Norway are situated in the two different corners of Europe. They are two countries with different economical and historical developments, health care system models and distinct ways of organizing and financing the health sector. Along with the many differences, similarities between their health systems also occur. RESEARCH QUESTIONS: My main research question is “How are the health care systems of these two countries similar and dissimilar?” I will try to answer it through answering three more special questions. First, “How do these systems perform with regard to health (life expectancy), access to health care, quality of the care provided and cost-efficiency (or resource use) and what are the main challenges facing the two countries? Second, “How do the health care systems, defined by how they are organized and financed, vary?” Last but not least, “What are the politically feasible health care system strategies these countries should pursue in the coming years to increase their performance in the area of health?” METHODS: This cross-national comparative research is based on selected documents about the health care systems of Bulgaria and Norway. These are on one hand documents giving factual, to large extent quantitative, information about the two health (care) systems. To interpret my findings I have used several, more qualitative reports and research studies, including research about state- and nation-building by Stein Rokkan. FINDINGS AND RECOMMENDATIONS: There are of course both similarities and differences in the way the Bulgarian and Norwegian’ health care systems were and are organized, financed and developed. I have used different performance indicators, such as health, access to care, quality of services and efficiency (resources spent on health) to show how well the systems are functioning and have generally found that Norway perform better than Bulgaria. To characterize the systems as such I have used the term “business model”, and have, after Clayton Christensen, defined that as consisting of a combination of, value propositions, resource composition,, processes and financing mechanisms. I have used both Rokkan’s historical theory and Christensen’s applied business model theory to explain my findings. I have also used Christensen’s theory as a basis for recommending in which direction reforms in the two countries ought to go. My main recommendation is that the two countries, step by step, move toward a situation where the business models are well maligned with the nature of the various types of medical practice -, intuitive, empirical and precision-based practice