BMA: The healthcare system is underfunded, every second Bulgarian pays out-of-pocket for health

The healthcare system in our country is underfunded, and every second Bulgarian pays extra for medical services. This was reported by the Bulgarian Medical Association (BMA), citing data from a nationally representative survey by the Trend agency, presented during the forum “Priority: Health – from public attitudes to political decisions.”

Most often, out-of-pocket payments are for medications, followed by consultations with a general practitioner or a specialist. Less frequently, but still significantly, citizens pay for medical supplies and hospital treatment.

At the opening of the forum, the Chairman of the BMA, Dr. Nikolay Branzalov, emphasized that the topic of healthcare is not just an expert issue, but a social one. “Healthcare is not simply a system of rules, budgets, and institutions – it is the measure of the state’s attitude toward its citizens,” he stated, adding that the sector must be a cause that unites and transcends political cycles.

In her greeting, Vice President Iliana Iotova also emphasized the need for urgent measures, especially regarding high out-of-pocket payments and improving the status of doctors. The caretaker Minister of Health, Assoc. Prof. Mikhail Okoliyski, noted that in addition to staff shortages, key challenges include access to quality medical care and the development of prevention.

The survey data shows a clear distinction between trust in medical professionals and trust in institutions. 81% of respondents trust general practitioners, and 79% trust specialists. Trust in hospitals is also relatively stable. At the same time, trust in the National Health Insurance Fund (NHIF) and the Ministry of Health remains significantly lower.

Among the main problems identified by citizens are insufficient coverage of health services, the high financial burden on households, and doubts about the effectiveness of management and control. Most respondents believe that the package of services funded by the NHIF does not meet their real needs, most frequently citing the need for better coverage of imaging studies, preventive check-ups, laboratory tests, and treatments outside the scope of the fund.

A significant portion of citizens define health expenditures as a serious burden on the family budget, and the combination of high out-of-pocket payments and limited coverage creates an expectation for a broader package of services from the public system.

Other prominent issues include corrupt practices, the shortage of medical professionals, weaknesses in the management of medical facilities, and uneven access to healthcare across different regions.

The survey also records strong public support for the introduction of mandatory continuing education for doctors – a measure supported by 80% of respondents.

The Deputy Chairman of the BMA, Dr. Ivan Madzharov, pointed out that compared to 2018, the share of uninsured individuals has decreased from 9% to 5%, but awareness remains low – about 55% of citizens do not know on what income they are insured.

The most significant change is in the assessment of the NHIF service package – while in 2018 there was a balance between positive and negative opinions, in 2024 nearly two-thirds of respondents believe it does not meet their needs. Parallel to this, the share of people who pay out-of-pocket for health has increased from 23% to 50%.

According to Dr. Madzharov, the system appears formally stable, but this is achieved at the expense of increasing out-of-pocket payments and a sense of insufficient coverage of medical services.

The results of the study were discussed during a debate involving representatives of the legislative branch and the parliamentary health committee.