Personal responsibility for health in Bulgarian public health law and social legislation

BackgroundIn the last decades all health systems have experienced a lack of resources. Against this background, the idea of applying personal responsibility of the patient as a criterion for allocation of resources (PRCAR) is gaining increasing attention. Bulgarian healthcare reform has been marked by the implementation of many new strategies, that grounded our scientific interest towards investigating PRCAR in Bulgarian public health law and social legislation.MethodsThrough a search of national legal databases 7 documents were selected and subjected to content analysis.ResultsProspective responsibility was found in two and retrospective responsibility - in three documents, two of which imposed explicit penalties on the patient. Two documents did not distinguish between the types of patient responsibility. PRCAR was found to be controversial through the prism of the social justice principle. The discussion was conducted through the perspectives of evidence translation of research to law, particularities of social cohesion in Bulgaria, and the interpretation of principles of public health ethics.ConclusionAlthough PRCAR was traceable in Bulgarian legislation, no supporting arguments for its introduction were deduced. The applicability of PRCAR should be further studied and wider public debate should be initiated. center dot In the context of insufficient healthcare resources experienced by all healthcare systems, the idea of applying the personal responsibility of the patient as a criterion for the allocation of resources (PRCAR) is appealing.center dot If striving for a common European vision on PRCAR, then each European country's view on the subject would be of key importance, and studies in this direction are necessary.center dot Our manuscript offers an in-depth expert analysis of the presence of PRCAR in public health law and social regulation in Bulgaria, which is one of the more recent EU member states but experiences the same developmental trends as other European healthcare systems.center dot As PRCAR is still an under-researched concept, our results will be of particular interest to other public health researchers.