The concept of personal responsibility in Bulgarian health and social legislation

BACKGROUND: In the context of scarce health care resources, national policies and legislation increasingly advocate patients’ personal responsibility for their ill health. This report aims at studying the concept of personal responsibility as a basis for resources prioritisation in Bulgarian health and social legislation. METHODS: Official normative documents were subjected to content and comparative analysis. RESULTS: Indirect personal responsibility can be found in the Bulgarian Health Act, Art.94 stating the duty of the patient to take care of his own health. Further, in the liver transplant algorithm of the Recipient Selection Ordinance, it is possible to distinguish a hidden criterion of patient's responsibility. One possible interpretation of Article 12 of the Code of Professional Ethics of Physicians in Bulgaria is the right of a physician to refuse medical care on the grounds of lack of trust due to patient's non-compliance with prescriptions. The latter correlates with the idea of prospective responsibility. Direct personal retrospective responsibility is imputed in the Health Insurance Act, Art. 111, where persons who themselves have damaged their health or in a state of alcoholic intoxication or drug abuse have damaged the health of others, must reimburse the costs of the NHIF. We also find clearly defined personal responsibility in the Social Security Code, Art. 46, according to which monetary compensation for temporary incapacity is not paid to insured persons who intentionally damage their health. There is no official data on the applicability of these legal norms. CONCLUSIONS: Although in a less categorical form and not in relation to access to specific planned treatments, the idea of the personal responsibility is embodied in the Bulgarian legislation. It is necessary to accumulate further data on the applicability of these norms, as well as to study the views of patients, users of social services, professionals and general public. KEY MESSAGES: • Personal responsibility is gradually entering Bulgarian legislation as an official criterion for the allocation of social and health resources. • It is necessary to accumulate further data on the applicability of the prescribed legal norms, as well as to study the views of patients, users of social services, professionals and general public.