{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T22:50:14Z","timestamp":1762296614943},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2002,11,11]],"date-time":"2002-11-11T00:00:00Z","timestamp":1036972800000},"content-version":"vor","delay-in-days":41,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Planning &amp; Management"],"published-print":{"date-parts":[[2002,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Throughout the 1990s, the Soviet\u2010style model in central and eastern Europe that provided free health services has been subject to radical reforms. Socio\u2010economic inequalities have also increased but there is little information on inequalities in health care utilization. This paper examines the pattern of illness behaviour in Bulgaria, seeking evidence of inequalities in access to services and eliciting users' pathways to care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Analysis drew on a representative population survey in Bulgaria (1997). The financial determinants of service use were tested in a multivariate model adjusted first for age, and then for age, marital status and self\u2010reported health. In\u2010depth interviews with users and providers addressed pathways to care, use of connections and other informal strategies to obtain care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>As expected, rates of illness vary with income, with highest rates among the poor. After adjustment for illness, consultation rates are relatively equal across income levels, with the exception of worse\u2010off women who tend to consult more. For first contact, there are few differences according to income, with the better off preferring secondary level. Pathways slightly differ, with women more often treated in primary care. Private sector utilization is low. Qualitative research reveals well\u2010established strategies to obtain more advanced care, including use of connections, informal payments and use of emergency services.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An apparent lack of inequalities in access to care conceals a more complex picture in which income and gender influence the pathways taken through the system. Copyright \u00a9 2000 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hpm.687","type":"journal-article","created":{"date-parts":[[2002,11,12]],"date-time":"2002-11-12T18:41:50Z","timestamp":1037126510000},"page":"377-395","source":"Crossref","is-referenced-by-count":19,"title":["Access to health care in a system transition: the case of Bulgaria"],"prefix":"10.1002","volume":"17","author":[{"given":"Dina","family":"Balabanova","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"McKee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2002,11,11]]},"reference":[{"key":"e_1_2_1_2_1","unstructured":"AinsworthM KodaG LwihulaG MujinjaP OverM SemaliI.1992.Measuring the Impact of Fatal Adult Illness in Sub\u2010Saharan Africa. An annotated household questionnaire. 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