The Bulgarian state spends the lowest percentage of its gross domestic product on healthcare among EU countries, which leads to huge private co-payments for treatment by Bulgarian citizens and conflicts in the healthcare system, according to an investigation by Euractiv.

According to data from the Bulgarian Association for Patient Protection, EU countries spend an average of 9% of GDP on healthcare. Bulgaria is close to this level of health care costs, but half of this money is paid by the citizens.

Many Bulgarians also complain about corruption in the healthcare system.

More than 60% of Bulgarians do not believe that getting good health services and treatment without payment is possible, and another 45% are convinced that this is only possible if a person has connections in medical circles.

These are some of the results of a large-scale representative survey of public opinion about Bulgaria’s healthcare system conducted by the National Centre for Parliamentary Research and published in early November 2023.

The Ministry of Health told Euractiv that it is working to reduce the widespread practice of private co-payments for treatment that patients have already paid for through their health contributions.

Health experts commented on condition of anonymity that there are reports that additional payment for treatment exceeding 60% of the value of the service is sometimes necessary.

The Bulgarian health system works on a solidarity basis, and health contributions are 8% of the salary.

In private hospitals, patients often pay large fees for administrative services for examinations otherwise paid by the National Health Insurance Fund (NHIF), for example, for the processing of their documents by the NHIF or for issuing an excuse note for school or sick leave.

The larger co-payments are made when, for some reason, state-subsidised hospitals and GPs cannot fulfil their obligations, so patients are pushed to private examinations and co-payments for operations and drugs.

The Ministry of Health and the Bulgarian Medical Union are in conflict over the health budget. The medical industry is unhappy because Bulgaria spends significantly less than other EU countries on healthcare.

Health Minister Hristo Hinkov said the money for health is increasing, and the NHIF will be allocated €4.9 billion in next year’s budget, or €600 million more.

He pointed out that the healthcare contribution in Bulgaria is the lowest in the European Union, while there is a parallel hospital system and patients pay almost 50% of the treatment costs.

Money increases, mistrust remains

Political scientist Parvan Simeonov recently presented the “Gallup International Balkan” study on the problems of healthcare financing, which shows that Bulgaria has a problematic health status due to the low efficiency of healthcare costs. Because of this, citizens have a negative attitude towards the system.

“A total of 37% of people who pay health contributions in Bulgaria think that they [contributions] are too high. Another 42.5% think that they are normal, and 3.8% think that they are low, which is an indirect indicator of the distrust in the financing model in our country,” Simeonov commented.

“Only 20.2% admit that they do not know the amount of the health insurance they pay, and this share is the highest among the youngest participants in the survey.”

According to Dr Tsvetan Dimanov from the National Association of Private Hospitals, the health funding is insufficient and unfair because the public healthcare contribution in Bulgaria is the lowest in the EU while Bulgarian doctors work with the same equipment and medicines as the doctors in the EU.

“In Germany, however, the healthcare contribution is 14%, not 8% as in Bulgaria. There is no country in the world with more affordable health care than Bulgaria, but the majority of Bulgarians believe that health care should be free,” he commented.

A change in the law

Surcharges for treatment are becoming an increasingly serious problem.

While prices of medical services are lower than the average for the EU, Bulgarians also have much lower income than citizens in other countries in the bloc. The cheapest examination with a doctor already costs 40 euros or more, and can reach €350 for consultation with a reputable specialist

The average salary in Bulgaria before taxes is €1,000 euros.

The Minister of Health has repeatedly stressed that his personal priority is the reduction of private co-payments for patients. For this purpose, an amendment to the legislation will be proposed to establish clear rules for co-payments in the healthcare system.

[By Antonia Kotseva, Krassen Nikolov, edited by Vasiliki Angouridi/Zoran Radosavljevic | Euractiv.com]

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