In the current organization of medical care in detention facilities primary medical examinations (initiated by the patients) are guaranteed, and are well above average. The NPM finds that the equipment and furniture of medical practices is not sufficient to meet the requirements of available and operable medical equipment and furniture, valid for a GP surgery. Prophylactic activity and dispensary observation of the chronically ill patients (i.e. actual healthcare) is not made in accordance with the current medical standards approved by the Ministry of Health, but in accordance with underestimate criteria. In general the health institutions in the penitentiary system of the inmates are not provided in full package of medical services guaranteed by the NHIF. The practice established in European prisons is to make use of external service allowing instead for a doctor on the staff to use several external experts with different specialties in the same public expenditure and significantly better health service. By recent amendments in the LIPSD of December 2012 the existing model of acquiring health insurance was changed, all prisoners acquire the status of health insured persons having continuous health insurance status as from the date of their detention. Thus some of the problems associated with discontinuous health insurance rights of most inmates were overcome. The NPM emphasizes that by this legislative change responsibility of the Bulgarian state for payment of medical services for inmates is transferred to the compulsory health insured persons. The question associated with spending of funds from the state budget for payment of the health insurance remains open, on the one hand, and on the other hand—for financing medical centers and hospitals of the penitentiary system. For decades, these hospitals do not meet standards for contracts with the health insurance. Thus they can not use the NHIF funds and their activities are funded by the budget of the Ministry of Justice. The existence of such hospitals in their current form can only be justified by reason of not having security in external hospitals. Possible solutions to optimize patient care for inmates are either organizational separation of prison hospitals as legal entities with the necessary investments in medical equipment and additional staff from institutions despite their subordination to meet the requirements to contract with NHIF, or their closure and provision of such activity by other existing hospitals in the system of civic healthcare system. The NPM's conclusion is that we need a thorough discussion on amendments to the existing model of healthcare to people in prison, prison dormitories and detention facilities in order to provide and ensure equal access to health care compared to other citizens through efficient spending of public funds. Education and Training 16 Annual Report of the National Preventive Mechanism | OMBUDSMAN OF THE REPUBLIC OF BULGARIA