Bulgaria: Health System Review

Area of Science:

• Public Health
• Health Policy
• Health Economics

Background:

• The Bulgarian health system operates under the 2015 National Health Strategy 2020, aiming for decentralization and integrated care.
• Despite strategic goals, the system retains centralization and a single-payer structure, with limited reform implementation.

Purpose of the Study:

• To analyze the organization, governance, financing, provision, reforms, and performance of the Bulgarian health system.
• To identify barriers to reform implementation and assess the system's effectiveness in improving health outcomes and financial protection.

Main Methods:

• Review of developments in Bulgarian health system organization and governance.
• Analysis of health financing, healthcare provision, and reform initiatives.
• Assessment of health system performance using key health indicators and expenditure data.

Main Results:

• Limited implementation of reforms like decentralization and strategic purchasing due to political fragility and stakeholder resistance.
• Progress in some health indicators (e.g., life expectancy) lags behind EU averages; amenable mortality shows unsteady improvement.
• High and increasing out-of-pocket spending (47.7% in 2015) indicates poor financial protection and exacerbates socioeconomic and regional inequities in healthcare access.

Conclusions:

• The Bulgarian health system faces significant challenges in reform implementation and performance improvement.
• Addressing political and stakeholder barriers is crucial for advancing reforms.
• Urgent reforms are needed to enhance financial protection, reduce inequities, and improve healthcare accessibility, particularly in rural areas.