44% of Bulgarians visit a doctor only when a problem arises; health experts warn of low health literacy

Nearly half of Bulgarians seek medical assistance only when they already have a health problem, while poor prevention, distrust in institutions, and a lack of sufficient health literacy remain among the main obstacles to more effective healthcare in the country. This became clear during the forum “The Health Literacy of Bulgarians – Key to Better Health: Challenges and Solutions,” organized by the Bulgarian Hospital Association (BHA), where data from a nationally representative survey by the Trend agency was presented.

According to the study, conducted in November 2025 among 1,006 adult Bulgarians, 44% of people visit a doctor only when they are in pain. Only 38% indicate that they undergo all preventive check-ups for the year, while 13% visit a doctor once every few years.

“What is striking is that women pay more attention to prevention than men,” noted Dimitar Ganev from Trend.

The data outlines a worrying picture of health literacy in Bulgaria—a topic that, according to forum participants, is key to the sustainability of the healthcare system.

“Without improving health literacy, neither a sustainable healthcare system nor real healthcare reform is possible,” stated the Chairperson of the Bulgarian Hospital Association, attorney Svilena Dimitrova.

According to her, low preventive activity, distrust of institutions, and insufficient funding create unrealistic expectations of the healthcare system.

According to the BHA, there are five main pillars upon which the improvement of health literacy should be built: awareness and health literacy, an active and responsible lifestyle, reduction of harmful factors, prevention and screening, as well as the sustainability and financial stability of the healthcare system.

The Chairman of the Bulgarian Scientific Society of Pharmacy, Prof. Georgi Momekov, emphasized the need for a long-term strategy to reduce health risks.

“There are still issues with alcohol consumption, tobacco use, and even salt intake. These are harmful habits linked to early behavioral patterns that can be formed within the family,” he said.

Prof. Momekov gave examples of behavioral models established in childhood—ranging from traditions surrounding alcohol consumption to widespread health beliefs without a scientific basis.

According to the Chairman of the Bulgarian Medical Association, Dr. Nikolay Branzalov, health literacy begins in the family and should be part of one’s upbringing.

“We shouldn’t just reduce smoking or stop drinking cabbage juice. Health literacy is a much broader concept. A targeted national policy is needed to emphasize the places where people can obtain accurate information,” he said.

The Governor of the NHIF, Assoc. Prof. Petko Stefanovski, emphasized that the institution is expanding its communication channels to citizens.

“Since the new generations do not trust paper, the ‘NHIF for You’ campaign has penetrated all social networks,” he stated.

According to him, the Health Insurance Fund continues to work with health mediators among vulnerable groups to improve awareness regarding health insurance and prevention.

Assoc. Prof. Tsvetelina Spiridonova from the Bulgarian Hospital Association also drew attention to the role of hospital physicians.

According to her, patients should be better informed on how to exercise control over the medical activities performed on them, how to use their electronic health records, what rights they have, and what follows after hospitalization.

She also emphasized the need for people to be better informed about when they should seek emergency care and which medical facility they should contact.

Health economist Arkadi Sharkov focused on the economic impact of good health literacy.

He cited World Health Organization data, according to which reducing smoking brings a 19-fold return on investment, health education and vaccination in children—15 times, and limiting screen time—36 times.

“Every euro spent on health literacy leads to a return of between 2.5 and 3 euros,” he noted.

The Trend survey also shows that 51% of Bulgarians do not smoke.

39% use traditional cigarettes, 5% use only heated tobacco products, and 4% combine different products depending on the location and restrictions.

Among users of heated products, nearly three-quarters cite convenience as the main reason for their use, while 52% believe they are less harmful.

Regarding dietary habits, only 10% of respondents claim to constantly limit unhealthy foods and drinks, while 47% do so only sometimes.

During the forum, representatives of hospital organizations and the Bulgarian Medical Association signed a memorandum of cooperation to improve health literacy and public health in Bulgaria.

Participants in the discussion were unanimous that without better awareness, more prevention, and the restoration of trust in institutions, sustainable healthcare reform will remain a difficult goal to achieve.