Bulgaria has a high rate of health expenditure compared to other European countries. A new WHO/Europe report launched today in the Bulgarian parliament shows that in 2018, 1 in 5 households paid 40% more than their ability to pay for healthcare. Expenditure on health can mean that a family can no longer afford other basic needs, such as food, housing and electricity.

People who pay out of pocket for outpatients are the ones driving the health costs in Bulgaria. This type of spending hits poor families, the elderly and people living in rural areas, and has increased over time, says a new report ‘Can people afford health care?’ New evidence on financial security in Bulgaria’.

Although the country has made progress in some areas, foreign payments accounted for 39% of health care costs in 2019, above the European Union (EU) figure of 21%, the report said.

Tamás Evetovits, Director of the WHO Office in Barcelona said: “Bulgaria’s high dependence on external payments for health care is a challenge for the entire health community – the idea that everyone should be able to use quality health care without facing financial problems. for Health Systems Financing. “The report it recommends focusing on ways to ensure that the National Health Insurance Fund covers all people and that it provides rights to people who cannot afford to pay for drugs and other medical services.”

“Bulgaria has taken steps to improve access to health care and reduce financial burdens for people who use health care, but significant gaps in health care remain, especially for low-income families,” said Antoniya Dimova, Dean of the Faculty of Public Health. Medical University-Varna is the lead author of the report.

“The new analysis provides a detailed overview of the current situation and identifies several ways to strengthen financial security in our health system,” said Anton Tonev, Chairman of the Bulgarian Legislative Health Committee.

Gaps in coverage

Reforms introduced in the last 10 years have increased the health benefits provided by the National Health Insurance Fund (NHIF) and are aimed at increasing the NHIF budget. Despite these achievements, the report highlights the continuing gaps in health care.

About 15% of the population is uninsured and may have limited access to government subsidies. Only those who pay health insurance can get NHIF benefits. The government only gives grants to people who are in extreme poverty; Therefore, many low-income people need to donate but cannot afford to do so.

Co-paying is particularly burdensome for outpatient prescriptions, there is no waiver for co-paying multiple drugs, and there is no full co-pay rate. This is particularly harmful because people have to pay part of the cost of medicine in Bulgaria through co-payments, and medicine prices are high compared to other EU countries.

Making healthcare accessible to everyone

In order to improve access to health care and financial security, policies should focus on finding ways to make NHIF accessible to all. The WHO report emphasizes that penalizing people who cannot afford health insurance by denying them access to health care hinders progress in health care worldwide. The report’s recommendations to address this are as follows:

  • ensure that the NHIF covers people below the poverty line who are not eligible for public assistance;
  • freeing poor families and people with chronic diseases from co-payments and replacing the cost of out-of-pocket medicine with, for example, a small fee for each medicine; and
  • reduce the cost of medicine and increase the budget allocated to health, as public spending on health is still low in Bulgaria compared to most EU countries – 4% of GDP in 2019 compared to the EU average of 6%.

WHO helps countries to access universal health care

Financial security is a priority for global health, which is at the heart of the European Program of Work, WHO/Europe’s strategic framework. Through the WHO Barcelona Office for Health Systems Financing, WHO/Europe monitors financial security – access to health care – in more than 40 countries. Financial security is an indicator of the Sustainable Development Goals and part of the European Pillar of Social Rights. The WHO office in Barcelona also provides technical assistance in coordination with countries to reduce unmet needs and financial problems by identifying and addressing relevant gaps.

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