site.btaHealth Insurance Fund Supervisory Board Member: Healthcare in Critical Condition, System Ineffective Despite Solid Resources

Healthcare in Bulgaria is in a critical state, and despite significant resources, the system does not function effectively, said Friday Grigor Dimitrov, Bulgarian Chamber of Commerce and Industry (BCCI) representative on the Supervisory Board of the National Health Insurance Fund (NHIF). Dimitrov was speaking during a roundtable on boosting prestige and interest in nursing and midwifery professions.

"We have no concept for the development of healthcare under the new conditions, which have been in place since 2020. There is no comprehensive approach to the development of the nursing profession," Dimitrov said. According to him, nurses face low wages, lack of motivation to upgrade their qualifications, limited career advancement, significant wage disparities across clinics, and overall neglect of moral standards, with the profession itself suffering from a low public image.

According to Dimitrov, another issue is that one in five nurses works in Sofia, leading to severe regional disparities in the distribution of medical personnel across the country. He warned that the shortage of nurses would result in overworked staff, higher chances of mistakes, and insufficient care for patients. “Hospitals may close, not due to lack of funds, but because of lack of personnel, particularly municipal hospitals,” he said, adding that one-third of nurses in Bulgaria are over 60 years old.

Dimitrov also pointed to high levels of corruption within the healthcare system, noting that patient trust is low. The Government provides no additional funds for healthcare, apart from the budget for the Ministry of Health. All funds in the NHIF budget come from the country's health insurance contributions, he added.

Over the last decade, the NHIF has received BGN 54 billion, of which BGN 24 billion went to hospitals, BGN 14 billion for medications, and BGN 7 billion for outpatient care. Dimitrov emphasized that nearly 70% of the NHIF budget is spent on medication and hospital care, meaning the country allocates more money for treatment than for prevention. Bulgaria ranks eighth in the world in terms of spending on medication per capita. Each year, over BGN 5 billion is spent on medications, with the NHIF covering BGN 2 billion and the rest paid by patients.

"Our healthcare system is ineffective and does not meet patient needs. Patients are dissatisfied, and the medical profession is severely neglected in terms of compensation. Politicians are unwilling to reform the system," Dimitrov said. He added that economic indicators in the coming years will force the Government to implement reforms. 

The discussion was organized to mark the 30th anniversary of the Faculty of Public Health at Sofia Medical University, in partnership with Acibadem City Clinic-Tokuda.