Health Care in Bulgaria
Thinking of retiring in Bulgaria?
Reforms to the Healthcare system in Bulgaria began in 1999 – prior to that most Bulgarians relied on communist style State Clinics, or, alternatively, paid for very expensive special care.
The reforms provided health care paid for by NHIF (National Health Insurance Fund). This is a mandatory health insurance fund taken directly from wages paid. The increasing percentage of this deduction was aimed at gradually reducing State Care. Health care was decentralised, i.e. different Regions became responsible for their own facilities. By 2005 most clinics, private doctors and medicine had become decentralised. Hospital beds were reduced in an attempt to limit reliance on hospital care for routine treatments. This has not happened as fast as was hoped to meet criteria for membership of the EU. In 2004 there were 258 hospitals where it had been hoped to reduce these to 140.
Healthcare in Bulgaria is underfunded, 4.3% of GDP is spent on healthcare where the average in the EU is 7.8%. All doctors in Bulgaria are members of the BDU (Bulgarian Doctors Union) and politicians are intending to open this closed shop saying that it prevents competition. They argue that anyone with the qualifications and the customers should be able to practice without being a Union member. As a result of underfunding, nurses are badly paid, many of them on the minimum wage. Nursing care in hospitals is very stretched and many nursing duties in hospitals such as changing sheets and feeding patients is expected to be done by visiting relatives.
For foreign visitors initial emergency treatment may be free on production of a passport and a medical card as a member of the EU. This would give free medical, hospital or dental treatment although you still need to pay for medicines, some specialized treatments and laboratory tests. 90% of doctors are registered with BNIF and tourists may be able to reclaim medical charges. This is the same with dentists and pharmacies. If not registered with BNIF, tourists cannot reclaim costs of dentistry or prescriptions. To ensure reimbursement check that your pharmacist is registered and keep all receipts.
It is advisable to take out travel and medical insurance. Bulgarian hospital facilities are adequate, but specialised treatment and equipment is not always available. All major towns have a hospital, but staff are not always English speaking there may be limited nursing care.
Ambulances are free of charge in emergencies. Any tourist with special needs must make arrangements in advance. In the case of oxygen availability and dialysis equipment, these are subject to availability. Healthcare in more rural areal can be more difficult regarding hospitals and clinics and it may be necessary to travel long distances to see a GP or buy medicine.