HEALTH SINCE 1945: TRANSITION PERIOD, PART 2
The first act, which came to reflect the new attitude of the state towards health care, is establishment of the "Ministry of Public Health" /decree ¹ 284 from 9 September 1944/ as a central state institution for co-ordinating health. This is a realization, de facto, one of the main formulary from the health policy of the Party and the progressive medical community - which is the program documents of the expert group "Social Medic", working for long years under the auspice of the Bulgarian Medical Union. Dr. Racho Angelov /1873-1956/ is appointed first minister-of-health and Dr. Konstantin Kusitasev /1900-1955/ to the chair of secretary-in-chief: both well known as consistent public health activists, also, having a long dossier as professional revolutionaries. The new ministry is a split off organization, meaning, it came out as a corollary from the "Ministry of Interior & Public Health" and by right of succession taking its actives and passives.
The main tasks of health care in the transition period are formulated in the "Program of the Fatherland Front" from 17 September 1944. They are elaborated in the form of a State Plan, containing eleven points:
1. Cultural and vital elevation of the living standard of the people
2. Fight against infant mortality and provision of effective measures for combating infant diseases
3. System prevention of tuberculosis and all other infectious and social diseases
4. Sanitary development of dwelling settlements and all other populates
5. Qualification and re-qualification of medical care at all levels
6. Special health care of villages, factories, workshops, schools, etc.
7. Sports and physical activity recreation
8. Social care for adults, adolescents and other outcasts
9. Infiltration of the community with new health education
10. Making a universal medico-social insurance
11. Social care for motherhood
The platform is a demarcation of a new social approach for decision making in medicine, altogether, showing some realization of the principles of socialized medicine. The full project consist a booklet of some 40 pages and is printed in the early 40s but remained concealed by the group "Social Medic", viz. Kusitasev K., Mateev D. Project for State Health Plan. Sofia: Hudojnik Print, 1940.
Meanwhile, efforts are strained from the new government to overcome the ruins from the WW II. Activities, interest and participation from the side of the general population is shown towards the questions of health care. With voting on 11 July 1946 of the "Law for Cooperative Suffrage of Health Establishments" /LCSHE/, a foundation is laid for intensive development of health care. This is emphasized by minister Angelov on a briefing at the National Assembly: "Evidently, the present state of affairs /N.B. approximately, in the year 1946 the hospital bed supply is 1 per 1000/ need a corrective down-and-up …" The LCSHE arranges the following subjects of cooperation: 1. As a compulsory participants in the face of state and municipalities; 2. As a facultative participants in the face - coops, associations, societies, companies, etc. Consequently, the government emits obligation funds which are cashed unconditionally by the State Exchequer at a limited interest rate. This is, de facto, socialization of health care on a large scale.
Socialization on a small scale is attributed via district physicians principle. Pre-requisite for this act is the adoption of new "Constitution for People's Republic of Bulgaria" /5 December 1947/ - in Art. 81 is written, that: "Liability of the state is to take care of the health of the citizen". Furthermore, with a decree ¹ 43 from 21 December 1949, a new health maintenance organization is arranged, called, "polyclinics" and functioning on the basis of the former municipal health-services, workers health check-points, district ambulatories, etc. What is important here is that, towards, at the end of 1949 some 69,2 % of the total population were covered with "free" medical services. Here, in caveat, let us remark that much speculation has been held on the meaning of the term "free" health care. What is important here is that coverage was eligible for everyone, who, separately is employed in any kind of a state job. Thus, we say that 69.2 % is quite a good index for employment rate. The bad point is that re-imbursement rate often proved wrong and that is what "Marxian" economists could not foresight.
Speaking about "failure" is an issue from quality control. Our job is to give a chronology of events in the years after WW II and in the period of Cold War. Thus, we should try to enumerate briefly what happened in the first five years, something, which for the field of health care could encompass a lot of thick volumes. Firstly, on 12 June 1947 was voted the "Law for Sanitary Pharmaceutical Enterprise" /LSPE/ - enacting a process of nationalization for drug industry and marketing. Secondly, with decree ¹ 4 from 12 May 1948, all private hospitals and clinics were expropriated and put under the umbrella of the Ministry of Public Health. Thirdly, with decree ¹ I-20-874 from 19 August 1949, all establishments from the "Fund for Social Security" /FSS/ are expropriated and a new institution, under state umbrella, is created - "State Institute for Social Security" /SISS/.
/to be continued/.
