site.btaStudy: Medical Establishments Contribute Directly BGN 1.2 Billion to State Budget

The direct contribution of medical establishments to the state budget is about BGN 1.2 billion, accounting for approximately 2% in 2022. These are the results of a study on the economic contribution of medical institutions in Bulgaria, carried out for the Bulgarian Medical Association (BMA) by IQVIA - Central and Eastern Europe (CEE). The total economic footprint of medical establishment is approximately BGN 7 billion, or 4.2% of the Gross Domestic Product  for 2022. Approximately BGN 11.6 billion is the economic contribution of medical institutions to the economy in 2022. This share includes indirect effects (intermediate demand along the economic chain for healthcare services) and induced effects (spending by medical professionals in other parts of the economy). Salaries paid in 2022 in medical institutions totalled almost BGN 3 billion.

Nearly 106,300 persons are employed in the health sector. This represents nearly 3.5% of the total workforce in Bulgaria. The survey covered 8,900 doctors' practices, hospitals and other medical institutions. Nearly 29,600 are medical practitioners, including persons who have graduated from a medical university and are licensed and persons providing services directly to patients. Dentists are excluded from this share. Medical staff (nurses, lab technicians, midwives, paramedics, etc.) number nearly 43, 000. The national average is 4.6 doctors and 4.3 nurses per, 1 000 people.

Many of the specialists are either at retirement age or will soon enter retirement age, said IQVIA-CIE General Manager Luka Chichov.

"Medical professionals are unevenly distributed across regions in Bulgaria, which leads to differences in the economic contribution in different regions, as well as in the quality of medical care," the study said.

"The ageing medical profession and the lower number of nurses per capita compared to the EU average are putting pressure on the healthcare system, which is expected to worsen in the future," the study added.

From 2017 to 2021, healthcare expenditures increased, the data also shows. Medical institutions paid about BGN 80 million in corporate taxes and approximately 890 million BGN in social security contributions. Approximately BGN 240 million in total tax is paid by persons employed by doctors' practices, hospitals and other medical establishments, the data also show. The activities of doctors' practices, hospitals and other medical establishments also support the creation of nearly 460, 000 jobs in other sectors of the Bulgarian economy.

The healthcare system is by no means a burden on the country's economy, on the contrary it is one of the main drivers of the economy, said BMA President Ivan Madzharov. In his words, the state's funds in healthcare should be perceived as investments, not as expenses. He warned that the staff in the system is the most important. According to him, there is a personnel crisis in the sector.

During the event, experts commented on the need for legislative changes to improve the quality of the healthcare system. Some of the participants in the discussion noted that in some cases there is overregulation in our country, which creates barriers to access to treatment. Lawyer Velichka Kostadinova drew attention to compensation claims against hospitals, which leads to an economic burden for medical institutions. The number of medical malpractice lawsuits increase every year. The last two years there has been an avalanche increase in cases, the lawyer said.

The issue of regional disparities in healthcare was also a focus of the discussion. For me, the demographics are based on two main things - certainty that the state will not do something to jeopardize business, and the state's commitment to certainty in the healthcare system, commented economist Kuzman Iliev. There needs to be a long-term money policy for health care workers so that these people have a perspective, economist Lachezar Bogdanov said.