Main reasons for low coverage of preventive examinations of health insured people over 18 years of age according to general practitioners from Pleven region

General Medicine, 2024, 26(2), 8-13.

P. Kostadinova¹, K. Nedyalkov², S. Kostadinov¹

¹ Faculty of Public Health, MU – Pleven
² Faculty of Medicine, MU ‒ Pleven

Abstract. The purpose of the present study was to determine the main reasons for unsatisfactory coverage of health insured people (HIPs) over 18 years of age with an annual preventive examination performed by general practitioners (GPs). Material and methods. In January 2024, a direct individual survey was conducted with 151 GPs from the Pleven region. Additionally, information from the Pleven Regional Health Insurance Fund and from the annual reports of the National Health Insurance Fund was also used. Descriptive statistical methods such as the absolute number and relative share of individual categories have been applied for data processing and analysis. Of the methods of analytical statistics, chi-square analysis was applied. Values of p < 0.05 were considered significant. Results. It was found that 27 GPs (15%) covered less than 25% of the insured persons over 18 years old, 39 GPs (21%) – from 25 to 51%, 32 GPs (18%) – from 51% to 60%, and 81 GPs (45%) – over 60%. In total, for the Pleven district, the health-insured people over 18 years of age covered by a preventive examination in 2023 are 54.42% of those who are subjects to it. As the main reasons for the low coverage, GPs point to non-calling of the health insured, despite being notified; lack of interest from patients who do not have health problems; non-imposition of sanctions on non-appearances, as well as lack of time on the part of GPs and patients. As measures to improve coverage, most doctors point to the need to impose sanctions on patients, carry out information campaigns and additional leave for preventive examination. After the introduction of differentiated payment linked to covered patients, there is an increase in the number of those who are prevented. This measure is an incentive according to 63% of respondents, but half of them believe that it is not enough. In the case of doctors who covered less than 25% of the subjects, a lower relative share compared to the others in terms of acquired specialty in General Medicine is observed, more than half do not have hired staff and practices prevail in villages and in settlements outside the regional city. The conclusion can be drawn that the incomplete coverage of health insured persons over 18 years of age with preventive examinations is due to many factors related, on the one hand, to the qualification and organization of the activities of GPs and, on the other hand, to the awareness and responsibility of individuals for their own health.

Key words: preventive examinations, health insured people over 18 years, general practitioners

Address for correspondence: Assoc Prof. Penka Stefanova Kostadinova, MD, PhD, e-mail: pstefanova_pl@abv.bg