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Health Service

A system of social health insurance was introduced in Bulgaria in the late 1990s., leading up to the development of primary health care based on a model of general practice, and rationalization of the health care delivery network.
Many physicians, who previously worked as specialists in internal medicine, paediatrics, neurology and other specialties, became general practitioners (family doctors). In Bulgaria, the first contact of the patient with the health system is a visit to family doctor.
The Health Insurance Law adopted by the Bulgarian parliament in 1998, introduced a health insurance system, with only one health insurance agency and mandatory health insurance payments deducted from the personal income. Employers are responsible for enrolling employees into the health insurance fund. Fees are split between the employer and the employee and they are collected directly from employees’ salaries to the Bulgarian social security (NOI). Parliament decides the size of health insurance payments and each year determines the budget of the National Health Insurance Fund. Contributions from employed people amount to around 15 BGN a month. Self-employed persons must pay the entire contribution themselves. Dependant family members are covered by the employed family member making higher rates of contribution. The medical centers of non-hospital and hospital care have individual contracts with the National Health Insurance Fund and become the providers of medical care in the system of the compulsory medical insurance. Every compulsorily medically insured person can choose his / her own personal doctor specialist in general medicine (family doctor) from a medical center (having a contract with the National Health Insurance Fund), which provides a primary non-hospital aid. The family doctor is responsible for every health problem of his patient. Depending on the severity of the health problem, he decides the treatment or refers the patient with a relative document to a more specialized doctor.
This new system aims to guarantee social protection of population and to establish a precise and clear rules in the relationship between doctors and patients. There are several basic tasks it has set: to guarantee to every Bulgarian citizen affordable medical care to all levels of the health system, to provide quality medical services for patients, to create competition between doctors and health care centers for sick people, workers in the health care system to receive pay dignified and appropriate to their efforts.

Medical care in Bulgaria, dependant on the target and the volume of the implemented medical activity, is divided into two basic groups: Medical centers of hospital treatment and Medical centers of non-hospital medical treatment, distinguished as follows:
1)  Clinics of primary treatment:
2)  Clinics of special medical treatment.
Hospitals and clinics exist in all major towns and cities of Bulgaria. The best-qualified staff are concentrated in urban areas. Facilities in most Bulgarian clinics are adequate, but still many hospitals are in a poor state of repair. Specialised equipment and treatment may not always be available and in some instants, inpatients must buy necessities such as drugs and food. Bulgarian hospitals may treat foreign residents who hold European Health Identity Cards as foreigners from EU member states are required to provide copies of their EHIC when they register.

Consumer choice has also been extended through the expansion of privately provided services since it was legalized in 1991 (having been banned in 1972). At present, private practice involves mainly dental offices and physicians’ surgeries and consulting rooms, pharmacies, laboratories, and outpatient clinics and polyclinics. Services in the private sector are paid for out-of-pocket by patients if the providers are not contracted with the National Health Insurance Fund (NHIF). Patients who choose to see a doctor privately do so mostly for specialists, less so for primary care physicians. The standard of private health care in Bulgaria is of a much higher standard, but this is reflected in the fees private practitioners charge. Many foreigners come to Bulgaria to take advantage of its private healthcare system, which is considered much cheaper than that of its Western European neighbours.

Emergency cases are admitted to the nearest medical institution until their condition is brought under control or until, when they may be transferred to another hospital.

In the previous years, pharmacies were not regulated and it was possible to buy a wide range of drugs over the counter including antibiotics. Since 2007, a qualified pharmacist must run pharmacies, but it is still possible to obtain medicine, usually reserved for prescription in other countries, directly from the pharmacist.

It is important to report that Bulgaria has made significant steps of progress in respect to medical care in the last few years and this is only the beginning as the medical reform has recently started (1999) and has not been completely applied.