Analysis: Healthcare Inflation in Bulgaria Twice the National Average

Healthcare sector inflation in Bulgaria in 2026 is twice as high as the country’s overall inflation rate, according to an analysis of the health insurance system’s sustainability prepared by Health Metrics. This was reported by BTA.

According to experts, this is a clear signal of a deepening imbalance between expenditures and revenues in the system, which jeopardizes the sustainability of the National Health Insurance Fund.

A key factor for the growing pressure is the demographic structure. “Nearly half of the workforce in Bulgaria is over 45 years of age—a period in which the incidence of chronic diseases increases sharply,” noted Ekaterina Ilarionova. She emphasized that our country is among the fastest-aging in the EU, while preventable mortality levels remain among the highest.

The analysis highlights several systemic problems: increasing demographic pressure, a limited revenue base, and a lack of effective cost-containment measures. Approximately 11–12% of the population remains outside the health insurance system, further straining the budget. At the same time, funding for hospital care is increasing significantly at the expense of investments in prevention.

The share of out-of-pocket payments by patients is particularly alarming. According to Arkadi Sharkov, these are more than twice as high as the EU average, with Bulgaria ranking first in this indicator. In just five years, household healthcare expenditures have increased by about 60%, and nearly 77% of these out-of-pocket payments are for medicines—including those partially reimbursed by the health insurance fund.

Pressure on the pharmaceutical market is also intensifying. In the period 2022–2025, the discounts provided by pharmaceutical companies to the NHIF grew by approximately 115%. This calls into question the long-term presence of certain medications on the Bulgarian market, as domestic prices are determined by a mechanism based on the lowest levels in the EU.

External economic factors are adding to internal problems. The introduction of new tariffs on medicines and raw materials by the US is expected to have a direct impact on prices in Europe. Additionally, global supply chain disruptions—including the decline in traffic through the Strait of Hormuz—are already leading to serious medication shortages in some markets.

In response to these trends, Health Metrics proposes a package of measures to stabilize the system. These include increasing the health insurance contribution from 8% to 10%, expanding the coverage of insured persons, introducing targeted transfers through excise duties on health-damaging goods, and guaranteeing a minimum annual growth of the health budget of at least 10%.

According to experts, such measures would lead to higher financial sustainability, a reduction in hidden deficits, and better protection of households from excessive healthcare costs. It is expected that with an increase in the health contribution to 10%, revenues in the NHIF budget could reach approximately €7 billion.

The need for such reform is also supported by the Bulgarian Medical Association, which also insists on updating the health insurance model as a key step toward stabilizing the system.