HEALTH 1921-1945, PART 4

Let us continue our narrative by the beginning of WWII in September 1939. I have read somewhere a statement about Adolf Hitler: "Einem Trompeter gebe die Macht nicht". Whoever said it proved to be politically shortsighted. Hitler's war shaked up the world to an unmeasureable scale. What happened then is a matter of fact in numerous textbooks and files. We concentrate our attention on Bulgaria's destiny by the period and that is done, purposefully, via a presentation of renegade man Aleksander Tsankov /1879-1959/. Here is an article about him from Encyclopedia Britannica Inc., 1968:

"Bulgarian statesman, born in 1879 in the town of Oriakhovo and studied law at Sofia University, where he became professor of economics. In 1922 he became leader of a small group called the National Concord /Naroden Zgovor/, drawn from the intelligentsia of various political parties and the mass of former officers, which aimed at combining the dispersed national forces for a struggle against the semidictatorship of Aleksander Stamboliski. To him fell the premiership of the coalition government, representing all the political parties except the Communists, that took power on 9 June 1923, after military "coup d'etat", in the preparation of which Tsankov's National Concord had its share. Tsankov remained prime minister until 1926, when he was replaced by Andrei Liapchev. His tenure of office coincided with one of the most tragic periods in modern Bulgaria's history. The disturbance that broke out after Stamboliski's overthrow took thousands of lives.

On 9 September 1944, after Soviet troops had occupied Bulgaria, Tsankov formed a National Bulgarian Government in Austria under German auspices and tried to recruit a volunteer corps. The advance of the Russians put an end to these efforts; Tsankov surrendered to the U.S. forces and, for several months, was interned at Kitzbuhel in Austria. Later, he was released and emigrated to South America.

From 1948 he lived in a suburb of Buenos Aires, Argentina, where he died on 17 July 1959."

Prof. Aleksander Tsankov is important for medico-sanitary historiography because he is, presumingly, the architect of modern social security reform in Bulgaria. On 1 July 1924 is enforced the "Law for Social Security" /LSS/, which cancelled all active decrees by that time. The law makes a reorganization for social security concerning the main bio-social risks by introducing insurance with "Fund for Social Security" /FSS/ which is functioning at the "Ministry of Trade, Industry and Labor". Specific for the new system is the profile administration matrix, i.e. all organizations on state, public and private level are cooperative to a certain degree, given it is not prohibited by a specific other formulation. It is an old system of "leveling" coming from XVII century England, stirred in the Cromwellian army. But we are not going to dwell on the evolution of the concept right now.

The professional medical associations, subject to social security venture, are the Bulgarian Medical Association /BMA/ and the Bulgarian Dental Association /BDA/; they coordinate the operational activity for collecting the prestations and subsequently defend the interest of the insured. Thus, for the period until 1944, the mean number of workers and employees covered with ambulatory, domiciliary and some other services by the "Fund for Social Security" is: 1.24% versus 0.65% for the general population /N. B. these are numbers for services done, not for services paid/. However, towards the end of the period the costs for rendering such services are unrealistic, because: 1. An increasing devaluation of the bulgarian currency; and 2. The bureaucratization of the organization towards expenditures for administrative purposes.

On the left hand of the system /i.e. the object/ is situated the "Institute for Working-Medical Expertise", decreed with the same law from April 1924. We see here the principle that, whoever treats is the one who determines the length of treatment or "piggy-backing". For the first time the "Institute " administers: short-term, long-term and whole-term /or invalidity/ expertise on disability and done with the help of trained para-medical personal. Thus, for instance, the measurement for working incapacity /by organo-topographic signs/ is appreciated via percentage estimation and not by reimbursement of unrealized working income. We present here some data on medical examinations of insured people with "Fund " for the period 1930-1944 /N.B. index is 1939/:

Table 2:

Year

Medical examinations

Exams per 1000 insured

Disabled people

number

index

number

index

number

percentage

1930

1931

1935

1936

1937

1938

1939

1940

1941

1942

1943

1944

185 657

209 855

431 410

642 796

752 337

841 369

891 873

778 647

882 158

808 209

671 629

306 865

20.81

23.52

48.37

72.07

84.35

94.33

100.00

87.30

98.91

90.01

75.30

34.40

764.8

1981.3

2169.1

2424.4

2366.4

3629.2

3432.3

3102.0

2903.4

2595.3

2129.4

1472.8

22.28

57.72

63.19

70.63

76.81

106.02

100.00

90.37

84.64

75.61

62.04

42.91

433

425

21 084

21 586

19 023

10 167

952

7706

3577

0.23

0.20

2.50

2.42

2.44

1.23

0.11

1.14

1.16

 

It is evident from the table that operational activity of "Fund " is irregular. Also, the curve of medical examinations for the period 1930-1944 appear to have a binomial distribution.

/to be continued/