The 2026 NHIF draft budget passed the first reading in two parliamentary committees

The draft budget of the National Health Insurance Fund for 2026 was adopted at the first reading by the Health Committee and the Budget Committee in the National Assembly. In the Health Committee, it received support from 11 MPs against 9 “opposed,” while in the Budget Committee, there were 13 votes “in favor” and 8 “against.” Members of Parliament stated that a number of changes will be proposed between the first and second readings.

The Deputy Chairman of the Bulgarian Medical Association, Dr. Ivan Madzharov, emphasized that biomarker diagnostics should be planned within the funds for medical devices rather than in Medico-Diagnostic Activities (MDA) to avoid hindering its implementation. He also expressed concerns regarding the application of budget increases, particularly concerning hospital salaries and the need for raises for residents in outpatient care.

The Chairman of the Bulgarian Dental Association, Dr. Borislav Milanov, announced that an agreement has been reached to reduce co-payments for patients requiring full dentures, as well as to include a fourth dental activity for adults by the end of 2026.

On behalf of the Bulgarian Pharmaceutical Union, Mag.-Pharm. Dimitar Marinov supported the targeted funding for pharmacies in remote areas but noted that the lack of projected growth in the budget would limit the effect of the measure. He also questioned the actual implementation of minimum guaranteed basic salaries for pharmacists, as there are no clearly defined sanctions for hospitals that do not comply with them.

The Chairwoman of the Bulgarian Hospital Association, Atty. Svilena Dimitrova, stated that the budget growth is smaller than in previous years and may not cover the real needs of the system, especially in the context of inflation. She urged that the planned €260 million for medical specialists’ salaries be distributed through the prices of clinical pathways.

The Bulgarian Industrial Association expressed disagreement with the draft. According to Deputy Chairwoman Maria Mincheva, the mechanism for increasing salaries is incorrectly structured and should be conducted by the Ministry of Health in conjunction with employers and trade unions, without fixed amounts set in law.

MP Dr. Alexander Simidchiev from PP-DB noted that the growth in funding for outpatient care is twice as low as that for hospital care and that the NHIF reserve is insufficient, which creates uncertainty.

The Governor of the NHIF, Assoc. Prof. Petko Stefanovski, pointed out that the Fund implements the policy determined by the legislative and executive branches and that the funds for salaries will be distributed through two mechanisms—via clinical pathways and through targeted transfers. He added that over-limit activity has been reduced to approximately 5 million BGN per month and is not planned to be paid. Stefanovski also announced the idea of introducing a personal health insurance card to limit fraudulent hospitalizations.

Deputy Minister of Health Yavor Penchev explained that the philosophy of the budget is changing to avoid creating tension between different categories of medical staff, and that the ultimate goal is for everyone—from orderlies to academic staff—to receive dignified remuneration.