Healthcare is defined by rapidly advancing technologies and increased patient expectations, resulting in frequent disagreements between patients, their families, and medical practitioners. Historically, these conflicts have been settled through the adversarial court system, which frequently fails to produce equitable results due to unequal legal representation, procedural difficulties, and other shortcomings. This analysis investigates mediation, a type of Alternative Dispute Resolution (ADR), as a viable option for addressing healthcare disputes. Mediation is a voluntary, flexible, and confidential process in which a neutral third party organizes negotiations to help conflicting parties reach an agreement. Unlike litigation, mediation promotes open communication, empathy, and the preservation of relationships, which enhances patient trust and satisfaction. Furthermore, mediation resolves disputes more quickly and cost-effectively than traditional court proceedings, significantly reducing the emotional and financial burdens on all parties involved. This review examines the benefits of mediation, focusing on its role in preserving physician-patient relationships, reducing legal costs, and improving overall healthcare outcomes. The use of mediation in healthcare conflict resolution provides a more effective, compassionate, and lasting resolution that benefits healthcare institutions, practitioners, and patients.

Gene therapies (GTs) have recently emerged as revolutionary personalized therapeutic options. Despite their promising potential, challenges such as uncertainty regarding long-term health benefits and safety, along with extreme price tags, pose significant obstacles to patient access. Within the EU, the European Medicines Agency plays a pivotal role with regards to GT market authorization. However, national authorities are responsible for pricing and reimbursement, which results in fragment patient access within the EU. This study aimed to provide an overview of the complex landscape of post-market authorization accessibility for GT products in Bulgaria, comparing it with neighboring EU countries. We applied a mixed-methods approach, including desk research, public data requests, and list price comparisons. As of 1 April 2023, 14 GTs had a valid market authorization at the EU level. In Bulgaria, Kymriah^® was the only GT included in the Positive Drug List (PDL), with an official list price of EUR 335,636.94. Similar results were found in Romania, whereas five GTs were included in Greece’s PDL. Additionally, Zolgensma^® was found accessible in Bulgaria through an alternative individual access scheme at an estimated price of EUR 1,945,000.00. In conclusion, this study emphasized targeted policy interventions to address health inequalities and to ensure timely access to GTs within the EU.

Background/Objectives: The healthcare system is complex and emotionally charged, which frequently leads to conflicts between patients and healthcare providers as a result of inadequate communication and unmet patient expectations. This pilot study investigates patient awareness and the feasibility of mediation as an alternative conflict resolution method in healthcare. Methods: A cross-sectional survey of 40 Bulgarian citizens was conducted to evaluate their experiences with physician–patient communication, their opinions regarding the effectiveness of the legal system, and their awareness of mediation. Results: According to the findings, more than half of the respondents reported difficulties communicating with their physicians, and only 5% believed the judicial system was effective in resolving disputes in healthcare. While many were familiar with mediation, only 2.5% had used it to address healthcare-related problems. Conclusions: This pilot study underscores the need for targeted education and trust-building initiatives to facilitate the implementation of mediation in healthcare. Improving patient–physician communication and introducing mediation could enhance healthcare quality and patients’ trust, providing a more efficient and satisfactory conflict resolution mechanism.

Background: Bulgaria carries a high burden of colorectal cancer (CRC) but, at the start of this study, lacked a nationwide organized screening program. Understanding specialist views (particularly on mail-based fecal testing) is essential for effective policy development. Objective: The objective is to assess the attitudes towards, practices of, and perceived barriers to CRC screening among Bulgarian gastroenterologists, with a focus on the feasibility of mail-based fecal occult blood testing (FOBT). Methods: A cross-sectional survey of 38 gastroenterologists examined clinical use of FOBT, screening method preferences, and perceived systemic and patient-level barriers to CRC screening. Results: Among respondents, 57.89% reported using FOBT in clinical practice, and 71.05% indicated they would undergo the test themselves and recommend it to relatives. Colonoscopy was the preferred diagnostic tool for 84.21% of participants; however, the existing literature raises concerns about its feasibility for large-scale population screening. Key systemic barriers, rated on a 5-point Likert scale, included financial constraints (mean = 3.08), inadequate infrastructure (2.89), and healthcare workforce shortages (2.71). Patient-level barriers were led by low health literacy (4.13), lack of motivation (3.95), and procedural fears (3.26). A majority (84.38%) believed that mail-based FOBT would increase screening uptake, and 57.89% supported annual distribution of test kits. Nearly all respondents (97.37%) favored initiating screening at age 50. Conclusions: This study highlights strong support among Bulgarian gastroenterologists for a national CRC screening program, with particular endorsement of mail-based FOBT. Despite acknowledged systemic and population-level barriers, the findings suggest that such an approach could increase screening coverage, promote early detection, and support the strategic rollout of Bulgaria’s emerging cancer control initiatives.

The incidence of kidney diseases has been increasing in the last decade due to extended lifespan, which is often related to polymorbidity. Chronic kidney disease (CKD) and acute kidney injury (AKI) are associated with high morbidity and mortality, elevated costs for renal replacement therapy and heavy psychosomatic burden. At the same time, therapeutic options are limited to prophylactic and renoprotective medications and measurements, and they often cannot restore the impaired kidney function. With the development of cellular therapies new perspectives arise on the horizon whit promising potential- mesenchymal stem cells (MSCs) and induced pluripotent cells (iPSCs). Here we review the current possibility of both cell types in the field of nephrology and assess their cost implication.

The incidence of kidney diseases has been increasing in the last decade due to extended lifespan, which is often related to polymorbidity. Chronic kidney disease (CKD) and acute kidney injury (AKI) are associated with high morbidity and mortality, elevated costs for renal replacement therapy, and heavy psychosomatic burden. At the same time, therapeutic options are limited to prophylactic and renoprotective medications and measurements, and they often cannot restore the impaired kidney function. With the development of cellular therapies, new perspectives arise on the horizon with promising potential, including mesenchymal stem cells (MSCs) and induced pluripotent cells (iPSCs). Here we review the current possibility of both cell types in the field of nephrology and assess their cost implication.