site.btaUPDATED Forum Discusses Healthcare Funding in Bulgaria

The average level of health insurance in the country is 93.5%, with the share of health-insured persons being the smallest in the Sofia region and the largest (100%) in the regions of Smolyan, Razgrad, Kardzhali and Kyustendil, shows National Revenue Agency (NRA) data presented at a forum on financing healthcare, organized by Health Barometer, a civic initiative for periodic monitoring, analysis and evaluation of the state, development, efficiency and sustainability of the healthcare system in Bulgaria.

Petya Georgieva, an economist from the Institute for Market Economy, cited data from Eurostat showing that in 2021 the average level of healthcare costs in the EU was over 10% of the Gross Domestic Product, while in Bulgaria it was 8.6%, with around 5.5% being public costs and the rest direct payments from patients. Georgieva said that the expenses of the National Health Insurance Fund (NHIF) increase annually and are expected to increase, but the problem is in the distribution of funds. Currently, more than 46% of the expenses of the NHIF go to hospital care, and a quarter - to medicines, Georgieva added.

Parvan Simeonov, Director of Gallup International, presented the findings of a survey commissioned by Health Barometer, according to which trust in personal physicians is high, but trust in the NHIF is low. Over 75% of respondents said they trusted their GP, while 16.2% said they did not. More than half - 53.6% said they did not trust the NHIF, while 29.3% expressed trust and 17.1% could not answer.

The research was conducted between November 7-14, 2023, among 806 people through personal standardized face-to-face interviews, with one percent of the sample corresponding to nearly 55,000 people.

According to 42.5% of the participants in the study, the amount of the health contribution is normal, 37.3% answered that its amount is high, and 3.8% indicated that it is low. Two percent of those asked indicated that they do not pay a health contribution. Half of the participants did not express willingness to pay more for healthcare, even if this would improve health care in the country, the study also shows.

It would be best if the health contribution was intended only for personal use according to 60.2% of those asked, 19.6% said that the health contribution should go to a solidarity fund, and 20.2% could not decide.

Some 53.3% of respondents said that they knew what they were entitled to once they had health insurance, but 42.1% of the study participants did not go to the preventive examination they were required to have every year. Nearly 50% did not even attend the preventive examinations that their employer organizes, while 24.2% pay for their preventive examinations themselves.

More than 70% of those asked said that in the last three years they had not had to pay extra for something they thought was unnecessary. Nearly 75% said they haven't been asked for a "bribe" in the past three years, and over 80% said they haven't had to sign false documents.

Prof Daniel Valchev, founder of Health Barometer, summarized that Bulgaria's healthcare system has various problems, including: the management of the NHIF,  conflicting interests in the financial and administrative chain, poorly functioning control systems, including electronic systems to track current costs, lack of an electronic health record, rather fragile follow-up on documents, lack of a clear and durable regulatory framework for the introduction of new drugs. Most decisions are made at a political rather than an expert level, and it will obviously be necessary to increase funds in the sector, seek a clear regulatory framework regarding drug policy, as well as decide whether to separate emergency and hospital care units, etc., he also said.