Healthcare in Bulgaria

Medical staff are extremely well trained in Bulgaria, but the standard of facilities and cleanliness is not up to the standards of western European countries. The Ministry of Health is responsible for the progress, execution and supervision of the National Health Service and policy in Bulgaria. Regional Health Centres are in charge of administration in each of the 28 administrative districts of the country. Health insurance contributions are mandatory for the working population.

Bulgarians are entitled to free or subsidised state medical care from a doctor, free referrals to a specialist, reduced price medicines and dental treatment. All Bulgarians have a National Insurance number, which entitles them to use the state healthcare system.

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). Contributions from employed people amount to around 15 BGN a month. The figure is determined each year by the Bulgarian parliament, who decides what the budget for the National Health fund should be. 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 unemployed, the poor, pensioners, students, soldiers, civil servants and vulnerable categories, like the Roma population, are exempt from payment. 

Registered Foreign residents must contribute to the Bulgarian national insurance fund regardless of whether they are employed or not, otherwise they can take out private healthcare. There is also a belief that Bulgarian hospitals may treat foreign residents who hold European Health Identity Cards under this reciprocal scheme as foreigners from EU member states are required to provide copies of their EHIC when they register. 

Private Healthcare
The standard of private health care in Bulgaria is of a much higher standard, but this is reflected in the fees private practitioners charge. The system for reimbursement of private medical charges is also time-consuming. 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.

Most small towns have at least one doctor but patients can register with a doctor of their choice in any town. Doctors are responsible for referring patients to specialists and hospitals, but they are not well trained in general practice and tend to defer making referrals to specialists or hospital. Patients who visit specialists without a referral must pay for any services administered.

Some companies have their own clinics, which employ a GP to serve the medical needs of its work force.

Under-the-table payments occur, particularly with the expat population, although membership of the EU has meant that such practices are being addressed.

Polyclinics were part of the old Bulgarian healthcare system. However, their function has changed, but the name is still visible on many of the former polyclinic buildings. Today, they provide specialist diagnostic and consultation centres for outpatient care. They are owned by the municipalities, which govern each region. GP practices can set up practices in the polyclinic and use the medical equipment there by paying low rents to the municipalities.

Some polyclinics offer only specialist outpatient care and are staffed by consultants who specialise in a particular field of illnesses. Some are attached to companies and others are open to the general population. Some of these specialist centres also contain dentists.

Hospitals and clinics exist in all major towns and cities of Bulgaria, but access to them from many of Bulgaria's remote villages can be extremely difficult. Bulgaria also has 30 specialist hospitals, which include hospitals for active treatment care for patients with acute diseases, cosmetic and surgical operations and obstetrics. Hospitals for completion of treatment care for people who require long periods of rehabilitation or long term care and hospitals for rehabilitation care for patients who need treatment like physiotherapy, which is aimed at getting them moving and back into society.
The best-qualified staff are concentrated in urban areas. Facilities in most Bulgarian hospitals are adequate, but the health service was grossly under-funded in previous years and many hospitals are in a poor state of repair. Specialised equipment and treatment may not always be available and in some instances, inpatients must buy necessities such as drugs and food. There is a low ratio of nurses to patients and consequently, general nursing duties like changing sheets and administering meals are expected to be done by the family members of the sick person. 

Patients are admitted to hospital after a doctor or specialist referral. If a patient goes to hospital without a referral, they will only be admitted once the hospital has assessed whether they really need hospital care and if this is deemed unnecessary, the patient must pay for their care themselves.

There are various types of hospitals in Bulgaria and patients will be directed to the one, which best caters for their needs regardless of where it is in the country. Patients can often end up hundreds of miles away from where they live for prolonged periods.

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.

Until recently, pharmacies, known as Apteka, 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.

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