Bulgaria

Background

In Bulgaria, healthcare reforms began in 1989, and by 1992, private dental practices, pharmacies and physician’s surgeries were formally privatised. GPs became gatekeepers and patients were no longer restricted to visiting the GP in their local area.

In 1998, the Union of Democratic Forces initiated radical reconstruction of the health system, which began by adopting the Health Insurance Act establishing a compulsory health insurance system. Within a year, financing moved from general taxation to contribution and general revenue payments. Contributions in 1999 were set at 6% of income with a payment ratio of 80:20 by employers and employees respectively. This ratio is set to be 50:50 by 2009. The establishment of the health insurance system helped define the relationship between National Health Insurance Fund users and providers. It also allowed for the formation of Voluntary Health Insurance, which provides complimentary health coverage as well as services not covered by the basic benefit package. However, in 2003 it was estimated that only 3% of people held this coverage.

Recent years

More recent reforms have been targeted towards achieving a higher quality of care. Efforts have been made to optimize the health service structure and develop human resource training. Creating incentives for better management and improving institutions’ accountability for health standards have also helped Bulgaria make huge strides towards upgrading the quality of care.

Current situation

Alongside these achievements, Bulgaria also currently faces issues similar to those confronted by other CEE countries. These include inefficient management, limited competition, an ageing population and huge out-of-pocket payments. A bill was passed in 2008 to help combat some of these issues, by introducing performance-related pay for hospital managers, improved emergency units and private competition in the health insurance market. However, the current government led by the Bulgaria Socialist Party (BSP) announced early in 2009 that it will postpone existing plans for reforms, claiming that it wants more time to re-evaluate Bulgaria’s health care model.

However, Bulgaria has been able to tackle the public health issues recently. For instance, MPs have approved (i) a smoking ban that will come into effect on 1 June 2010 (ii) the installation of health rooms in all schools and day-care facilities, and (iii) lowering the minimum age for medical treatment without parental consent from 18 to 16. In addition, in April 2009, Bulgaria received €18million from the Global Fund to contain and treat AIDS. Nevertheless, the state still faces severe shortages of medication needed for cancer treatment.

Bulgaria stats

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WHO Health Statistics (current data)                                         * Data for 2005

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