Bulgarian healthcare is gravely ill, and has been for a very long time. Nobody is happy with the health system: doctors say they are not paid enough and find work abroad where they earn more, hospitals say they are underfunded, and 80 percent of patients are unhappy with the medical services they receive and with the fact that even though they have health coverage they still have to cover, out of their own pockets, half of the cost of their medical treatment and medication. Many hospitals have amassed huge debts and, in their efforts to pay them off, are leaving their staff without salaries and their patients without medication and modern medical equipment. The past 10 years have seen a string of health ministers and heads of the only existing state-run Health Insurance Fund (NHIF) taking the hot seat and being replaced, all too soon, by the next in line. 

Things really got out of hand when it became all too obvious that even when NHIF subsidies were upped to almost 2 billion euro, with patients paying as much out of their own pockets, things were nowhere near on the mend. Perceiving where things are heading, current Minister of Health Kiril Ananiev proposed two packages of measures for dealing with the problems. The first involves abolishing the NHIF monopoly on the healthcare services market and giving competitive private insurers access to this, until now, exclusively state-run domain. The second package envisages additional compulsory health insurance with private health insurance companies, to the tune of 9 euro per month, an idea that is unacceptable to 94 percent of Bulgarians, all the more so that in instances when the medical service provided costs more than 360 euro, the patients will still have to cover the surcharges out of their own pockets. Experts, on the other hand, say that the 9 euro in question is such a paltry sum that it cannot possibly make any difference to the health system.

Reactions by politicians, experts and patients have been stormy and highly conflicting. “Though this conversation should have taken place years ago, we now have a chance to discuss, together, the necessary changes to the health system, so that they shall work in the interest of patients. Change is imperative,” said Kiril Ananiev at a round table on the future of healthcare in Bulgaria.

In Bulgaria, with its population of 7 million, there are over 340 hospitals with 52,000 beds, whose debts run to over 260 million euro. There are different kinds of hospitals in the country - general, specialized, university, regional, city, municipal, and private. And in all of them Bulgarians with health coverage are expected to be given, when the need arises, medical care, interventions and medication without having to pay any additional cash. But reality is a far cry from this – one would be hard put to find a single patient who has not had to pay additionally for their hospital stay – whether under the counter, or by official price list makes no matter. The same is true when you buy medicines at the pharmacy by prescription from your GP. The NHIF covers, on average, 50 percent of the cost of the medicines eligible for reimbursement, the remaining 50 percent are paid for by the patient. Estimates show that around 4 billion euro is spent every year within the system of healthcare, for a population of… 7 million.

At the end of the day there is money enough in the health system, even though the healthcare payments the population makes are comparatively low – 8 percent. It is this that is the butt of the criticism by the opponents of the two models of reform in healthcare. But the problem is not in the money, on which both models of reform are focused, and for which the authorities have continually been slammed. What is even more important, the opponents to the changes say, is the way in which the money is being spent, the incompetent way the health system is being run, the fact that many of the rules it functions by are flawed, obsolete and fall short, by far, of modern standards and requirements. There is one more problem – the 500,000 Bulgarians who do not have compulsory health insurance, but whom doctors and hospitals cannot turn away.

The new health minister has not been forcing his own opinion on the public, instead he has been saying he is seeking social consensus. The left-wing Bulgarian Socialist Party, BSP, holds the opposite view - it is preparing to submit to parliament a motion of no confidence in the cabinet, next Monday, over its policy in healthcare, which it is describing as “genocide”. Chances that the motion will pass are slim, yet it is a vivid illustration of just how grave the problems in Bulgarian healthcare are, problems that leave no one unaffected. That is why the authors of the draft reforms have been promising they will not be rushed before all controversial questions have been cleared up, something that, as the parliamentary healthcare committee has already said, is not going to happen this year.

English version: Milena Daynova