HEALTHY SIMOV KARAMITEV

awarding the educational and scientific degree of Doctor,

 Modern health systems face increasingly difficult challenges, driven by the a priori humanity of medicine and limited resources. A major problem of our health care is the failure to integrate hospice care into the health system. The ambition of modern health systems to provide universal health coverage is refracted through the prism of evidence-based health needs. The principle of equal health care throughout the life cycle of human life makes hospice care an integral part of modern health policies.

   The concept of hospice originates from the Latin word hospitum, which means private boarding house. The first institutionalized hospice was opened by Cecily Saunders in 1967 in London. Sweden launched the first specialized palliative care in Europe in 1977. The rapid growth of hospice populations in developed countries gives them a decent place in health systems.

   Historically, the development of hospice care in Bulgaria has gone through two phases.  The first phase of the non-medical model is associated with the development of organized care for terminal patients from vulnerable groups of society.  In 1989, Donka Paprikova, with funds from a charity campaign, created the Mother Teresa home, where terminally ill people are cared for. In 1994, the movement was registered as the Hospice Mercy Foundation. The second phase of the integrative medical model is characterised by the fact that in 1999 hospices were already registered as medical institutions.[1] The Law on medical institutions[25] provides in general for three large groups of medical institutions, according to their medical activities in Chapter Five – ‘Other medical institutions’. It is in this so-called ‘third group’ of medical institutions that the Bulgarian legislator has included hospices, nursing homes, dispensaries, etc.[13]

   The terms ‘palliative care’ and ‘hospices care’ have been used for many years with different interpretations. In some countries they are interpreted as unambiguous, in others they are interpreted as different in terms of scope and types of activity. In Bulgaria, since the last change in the ZLZ, the "hospice/paliative" model has been adopted, positioning hospice as the main providers of palliative assistance

   In this study, we will use the term hospice/palliative as unambiguous to hospice, i.e. hospice care will be presented as hospice/palliative care.

   The long transition in our country, the economic crisis, the deinstitutionalization of social homes and the lack of structures for palliative care have caused shocks in the reforming social and health system. The access and quality of long-term care in the country has deteriorated. There was an increasing need for hospice/palliative care structures. Recognizing these trends, the reformed healthcare system envisioned a reorganization of hospitals that would include the creation of hospice services.  Hospice was expected to meet hospice/palliative care needs and reduce costly hospitalisations. Unfortunately, this idea is not realized. There was a real opportunity to provide resources and develop hospice. The operation of these hospitals without public resources makes them unprofitable.[29]