Bulgaria’s healthcare is in a heavy crisis. The Bulgarian Minister of Health Kiril Ananiev announced recently that a new model in this country’s healthcare system will be introduced in the beginning of 2019. It will replace the current model, which proved quite inefficient.

The indebtedness of the Bulgarian hospitals amounts to over EUR 250 million and the National Health Insurance Fund owes some EUR 140 million to foreign hospitals, although it received an extra EUR 200 million in 2018 from the state budget. The healthcare system is on the brink of a collapse and poses a risk on the life and the health of over 7 million Bulgarian nationals. However, over 1 million Bulgarian citizens do not pay health insurance contributions, but continue to use medical services, because the hospitals do not have the right to refuse emergency, even if that service is not paid by the National Health Insurance Fund. In fact, the problem in this case boils down to the management of the Bulgarian healthcare system.

In 2018 over EUR 2.5 billion will be paid for health from the Bulgarian state budget. The country’s health system received EUR 200 million more as compared to 2017. The money paid for health perhaps exceeds EUR 4 billion, including the direct payments for medicines and the money paid for additional health services. Although the Bulgarians pay a mandatory health insurance contribution, they usually pay money from their own pockets when they need any additional medical service or a medicine. The National Health Insurance Fund never pays more than half of the price for a certain medication. Theoretically, the hospital treatment is paid by the National Health Insurance Fund, but practically no one is happy. The patients are complaining that they have to pay even for the smallest things. The hospitals are complaining that the National Health Insurance Fund does not reimburse all expenditures made during the medical treatment of the patients, because the money paid for clinical pathways have not been changed in the past decade. That is why almost all state-owned hospitals incurred debts. The so-called government hospital makes an exception to this trend, because it has been generously financed by the Bulgarian government. 

Practically, it turned out that the Bulgarian hospitals and the National Health Insurance Fund are deep in debt and currently are not able to pay off these debts. The companies supplying medication, equipment and materials to the hospitals lose most, because they have to wait long to receive their money.

Meanwhile, the private hospitals in Bulgaria are multiplying. Most of them also work with the National Health Insurance Fund, but they also receive less than what they pay for the medical treatment of the Bulgarian patients. However, there is no information of any private hospitals experiencing financial difficulties. These hospitals bought cutting-edge medical equipment. They employed some of the best doctors and pay decent salaries. The money paid to the state owned-hospitals by the National Health Insurance Fund is enough to cover the salaries of the personnel. However, wages in these hospitals are much lower than the salaries paid at the private hospitals. That is why many doctors and nurses left the state-owned and the municipal hospitals and were employed at private hospitals. At the end of the day, the state-owned hospitals found themselves in a vicious circle – they do not have money, because they do less medical services and they do less medical services due to the lack of money.

Bulgaria’s Minister of Health Kiril Ananiev who previously served as Deputy Minister of Finance wants to change the entire healthcare system, yet he refused to provide details. However, judging on his previous experience, we can expect that he would rely mainly on changes in the financial policy and the management of the hospitals. The state hospitals are looking forward to the forthcoming changes in the health system.

English version: Kostadin Atanasov