Which factors influence health services utilization in Bulgaria? Results of a cross-sectional survey.

Background: Research on the factors influencing health care services utilization in Bulgaria does not apply a particular model to analyze these determinants. To fill this gap, we apply the Andersen's Behavioural Model, a commonly used framework, to determine the factors that impact the utilization of health care services in our country.

Methods: Data are collected in an online survey conducted in Bulgaria in 2023 among consumers. The standardized questionnaire includes questions on the utilization of health care services used by the respondent during the preceding 12 months. We apply binary logistic regressions to analyze predictors of visits to general practitioners and medical specialists, as well as hospitalizations.

Results: The results of the regression analysis show that the factors of self-reported health status and the presence of a chronic disease influence the utilization of health care services except for general practitioner visits. Greater trust in general practitioners and hospitals is associated with an increased probability of undergoing examinations and hospitalizations. Predisposing and enabling characteristics appear as significant determinants of health care utilization.

Conclusion: The study confirms the relevance of the Behavioural Model for the use of health care services in the Bulgarian context. Further research on health outcomes and their impact on utilization can help determine the most efficient level and appropriateness of the use of health care services.