Assoc. Prof. Stefanovski: NHIF will pay all outstanding funds by the end of the year, but the lack of a budget blocks key reforms

This was the final meeting of the Supervisory Board for 2025. During the session, the NHIF report as of November 30 was reviewed and approved, along with internal compensatory changes across various sectors necessary to ensure health insurance payments through the end of the year. No disruptions are expected in this process. This was stated by the Governor of the Health Insurance Fund, Assoc. Prof. Petko Stefanovski, to journalists following the meeting.

“We guarantee that all invoices owed by the Health Insurance Fund will be paid by the end of the year,” he emphasized.

Regarding the unused 10 million BGN in specialized outpatient care, Assoc. Prof. Stefanovski explained that the analysis requires more time, as it covers a ten-year period from 2015 to 2025.

“It has been established that the number of referrals issued by general practitioners to specialists has remained practically unchanged over the last 10 years. At the same time, the funds for this activity have increased at least threefold. The share of unused referrals—those issued but not utilized—is about 20% annually for the entire period under review. This indicates that the problem is not specific to 2025,” he pointed out. According to him, the reasons could vary, and each will be verified within the respective reporting period. Among the possible explanations, he highlighted the lack of a specific specialist in a given region or a patient’s decision to choose a different specialist.

The Supervisory Board has decided to withdraw the Ordinance for the amendment and supplementation of Ordinance No. 10, which envisaged changes to the mechanism for paying rebates from pharmaceutical companies, Assoc. Prof. Stefanovski further announced. “At the previous meeting, I provided information on the progress of negotiations with the pharmaceutical industry. Last week, I held a meeting with all stakeholders to present their positions on the project. We decided to postpone the changes entirely, track revenues and expenditures during the first quarter of next year, and meet again in April 2026. Since becoming Governor, I have upheld the principle of negotiation and believe that decisions should be made jointly,” he said.

Assoc. Prof. Stefanovski also noted that due to the lack of a budget for 2026, it is not possible to sign the framework agreements with the Bulgarian Medical Association (BMA) and the Bulgarian Dental Association (BDA). “This is a serious concern for us, as the draft budget included a number of agreements reached during negotiations with the Medical and Dental Unions. In the current situation, nothing new can be negotiated, and the old framework agreements remain in force—with the same parameters, activities, prices, and volumes,” he specified.

According to him, the lack of a budget also definitively postpones the implementation of the electronic health card. “This was a beneficial measure for everyone—including the Health Insurance Fund—both as a method of reporting and for patient verification and access for outpatient specialists to patient records. The possibility of conducting a pro-generic policy—separating medicines into generic and original, budgeting them separately, and incentivizing the use of generic products, which are significantly cheaper than originals—has also been terminated,” the NHIF Governor added.