Reprofessionalisation in Post Communist Countries: The Case of Bulgarian Dentistry

Objectives: this paper examines the influence of post-socialist transition on health policy and health system reform in Central and Eastern European countries on the dental profession. Methods: focusing on dentistry in Bulgaria, the paper examines the case of re-professionalization of dentists under the radical social transformations occurring after the fall of communism. The paper examines the patterns of transition followed by Poland, Hungary, Czech Republic, and Bulgaria as contrasting transitions. It briefly describes the basic common features of economic transition, viewed also as pre-conditions for European integration, namely liberalization, stabilization, and privatization. A document analysis, including official statistics, laws and regulations, and a review of the research literature, was used. Analysis of numerical distributions was based on statistical data issued by the World Bank database, the European Union database, and the national health information and statistical institutions of those countries. A number of statistical indicators are compared to countries representing Asian (South Korea) and Iberian (Spain) models of overall transition. Results: Political, economic, and legislative issues have been involved in the transition. The role and position of dentistry changed, from employees at state-owned and state-directed entities, toward liberal autonomous professionals. A position they held before the advent of communism Conclusions: Before the communist regime in Bulgaria dentistry was an evolving professional presence within a developing state with European cultural and philosophical elements. It then followed a period of loss of autonomy, authority, academic and ethical freedom. It is now experiencing the resurrection of the normal status of the profession within a stratifying society. Following the mechanisms of liberalization, privatization, and stabilization of the health services market, the dental professions in post communist societies begin to resemble those in the West. This has been a process more aptly described as one of re-professionalisation than professionlisation.