Determinants of Outpatient Physician Visits and Hospitalizations in Bulgaria: A Cross-Sectional Study

The aim of this study was to identify the determinants of outpatient physician visits and hospitalizations in Bulgaria. Given resource disparities and hospital overutilization, understanding healthcare misuse or underuse could improve system efficiency and cost management.

An online survey was conducted in Bulgaria (January-February 2023) among individuals aged 18+ to collect information on individual characteristics and the use of health services. The cross-sectional study analyzed primary data from 1292 respondents. Determinants were selected based on the Andersen's behavioral model. The number of outpatient physician visits (GP, specialist) as well as the number of hospitalizations in the past 12 months were used as outcome measures. Four negative binomial regressions were conducted to assess associations between the independent and the dependent variables.

GP visits were positively associated with family size and trust in provider. Older age, higher education, and part-time or unemployed status were associated with lower private visits to specialists. Higher income predicted fewer GP and referral-based specialist visits. In contrast, long waiting times, distance, and transportation challenges increased private consultations. Better self-rated health was a negative predictor of GP and specialist visits. The presence of one or more chronic conditions was associated with more outpatient physician visits and more hospitalizations.

We have applied the Andersen's behavioral model, facilitating comparative analyses based on results in different countries and health systems. Future studies should explore how these utilization patterns influence health outcomes in Bulgaria.