Many Bulgarians are delaying medical check-ups and procedures due to unaffordable costs, with healthcare expenses placing a heavy financial burden on more than one million citizens, according to a survey commissioned by the Bulgarian Medical Association and conducted by the sociological agency Trend.
The study shows that nearly one in four adults in Bulgaria (around 1.25 million people) have postponed or entirely forgone a medical service or procedure in the past year because they could not afford it.
In addition, some 800,000 elderly Bulgarians face serious difficulties in covering monthly spending on medicines and healthcare services. “It is particularly worrying that close to 25% of Bulgarians delay medical tests or visits to specialists. This points to a very serious social problem,” Trend’s executive director, Dimitar Ganev, told Euractiv.
High out-of-pocket costs
The broader picture suggests that only 13% of Bulgarians do not experience difficulties paying for healthcare, while another 40% find costs a moderate burden. For the remaining share of the population – nearly half – healthcare expenses are a significant problem.
One of the key weaknesses of Bulgaria’s solidarity-based healthcare model lies in widespread informal and additional out-of-pocket payments for tests, treatment and hospital care.
In recent years, multiple studies have shown that public funding covers around 55–60% of total healthcare spending, with the remainder paid directly by patients, despite legislation guaranteeing universal access through a solidarity-based system.
“Co-payments are among the biggest problems for Bulgarians in the healthcare system. It is easy to see where most of the extra payments go – medicines and the choice of doctor in hospitals,” Ganev said.
The state fails to meet needs
Trend’s findings indicate that households are increasingly relying on personal savings, while the package of services covered by the National Health Insurance Fund (NHIF) fails to meet patients’ real needs.
“In many of our broader surveys, healthcare is consistently ranked among the top three problems in the country. This is also an issue in many other European states,” Ganev added. “What is specific to Bulgaria is the strong regional disparity in access and quality of services, as well as the perceived lack of control over healthcare spending.”
Nearly half of respondents (47%) believe the state should fully cover imaging diagnostics such as ultrasound, mammography, MRI scans and CT scans. While these services are formally free with a referral, access is often constrained by monthly caps.
The combination of high financial pressure and insufficient service coverage is shaping public expectations for broader access to state-funded healthcare.
“My impressions from years of working with the pharmaceutical and healthcare sectors show that there are hospitals in the country with extremely poor infrastructure and very low quality of care. In such places, patients can do little more than stay in bed and receive medication,” Ganev said. “However, these facilities cannot easily be restructured, as any attempt to do so would likely face strong local resistance.”
Commenting on the findings, Bulgarian Medical Association deputy chair Dr Ivan Madzharov noted that the share of uninsured citizens has declined to around 5% in recent years. However, despite increased public revenue, more patients are required to make additional payments to access care.
“Formally, the system is stable, but this comes at the cost of rising out-of-pocket payments and a growing perception that the benefits package does not meet real needs,” Madzharov said.
For several years, the Bulgarian Medical Association has advocated for an increase in health insurance contributions to address systemic funding gaps.
[VA, BM]
Source:
www.euractiv.com