Economic inequalities as a problem for the application of modern methods in surgery (the “gold standard” laparoscopic cholecystectomy)
Bulgarian Medical Journal, 2025, 19(3), 52-62.
R. Veleva1, L. El-Tal2
1 Department of Public Administration, University of National and World Economy – Sofia
2 Liver, Biliary, Pancreatic and General Surgery Clinic, Acibadem City Clinic Tokuda Hospital – Sofia
Abstract. The present treatise endeavors to elucidate the intricate nexus between economic disparities and the accessibility of avant-garde medical technologies, with a particular emphasis on the implementation of laparoscopic cholecystectomy as the “gold standard” in cholecystic surgery. A detailed theoretical exegesis has been conducted, meticulously tracking the genesis and evolution of the application paradigms. It has been established that despite the substantial advantages offered by minimally invasive surgical modalities, including faster convalescence and a mitigated risk of complications, their adoption in the Bulgarian context remains restricted. This investigation is based on an analysis of empirical data derived from authoritative statistical databases covering the period 2017-2022, which reveal pronounced disparities in the availability of laparoscopic cholecystectomy in various member states of the European Union (EU). The study further substantiates that elevated levels of economic inequality, quantified by the Gini coefficient, exhibit a correlative relationship with reduced access to contemporary surgical methodologies. The methodology used encompasses a correlational analysis that reveals a statistically significant inverse association between the Gini coefficient and the proportion of laparoscopic cholecystectomies performed. Bulgarian data indicate that it is one of the nations with the most pronounced economic inequalities and the lowest incidence of laparoscopic interventions in gallbladder surgery. The findings accentuate the imperative for strategic reforms within the healthcare system, aimed at increasing the availability of minimally invasive surgical procedures. It is incumbent on policy makers to devise initiatives that attenuate financial impediments facing patients and to foster investments in medical infrastructure and the edification of specialists.
Key words: economic inequalities, surgery, laparoscopic cholecystectomy
Address for correspondence: Assoc. Prof. Ralitsa Veleva, PhD, e-mail: ralitsa.veleva@unwe.bg