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This article deals with the social democratic aspiration of equitable access to health care in Bulgaria, a country in transition since 1989 from communism and a command economy to democracy and a free market. The focus is on access to health services and resources after the introduction of a universal health insurance system, with particular reference to formal and informal out-of-pocket payments for health care. The paper reports empirical results from a national household expenditure survey, supplemented with a semi-structured interview, conducted at the end of the survey period (April-May 2002). The results bring to light the groups in society who suffer most in this scenario: the poor, Roma, older persons and those living in towns and villages. The study reveals that the stated aim of the National Health Insurance Fund, to provide equitable access to health care, is a mirage rather than a reality, as the vast bulk of health care is self funded. This paper has particular significance for understanding the challenges faced by post-communist states in their attempts to achieve social democratic health care reforms. [ABSTRACT FROM AUTHOR]

This paper discusses the impact of neoliberalism on disability policy and activism. The paper highlights the neoliberalisation of postsocialist disability policy, as well as the convergence between the neoliberal critique of welfare-state paternalism and the advocacy of disabled people’s movement for deinstitutionalisation and direct payments (personal assistance). The discussion is supported by examples from Bulgaria and the United Kingdom. In conclusion, the paper argues that neoliberalism confronts the disabled people’s movement with two difficult tasks: to defend self-determination while criticising market-based individualism, and to defend the welfare state while criticising expert-based paternalism. [ABSTRACT FROM AUTHOR]

The mental health profile of Bulgaria has been compiled and following analysis of both the factual findings and the process of data collection a report has been prepared. The subject of discussion in the paper concerns several major findings: the discrepancy between what the policy documents state and the actual situation in mental health; the organizational culture, which alienates; and the peculiarities of the process of change and how it is driven under political pressure from outside the country. Analysis extends to encompass the influence of the general health reform on the mental health sector, the deficits of the leadership and how they impact on the effectiveness of the system, and the interdependence between the country's economy and the health sector. A conclusion is made about the need to consolidate the public health approach using the lever of international collaboration in the field of mental health. [ABSTRACT FROM AUTHOR]