Bulgaria: health system review
AbstractIn the last 20 years, demographic development in Bulgaria has been characterized by population decline, a low crude birth rate, a low fertility rate, a high mortality rate and an ageing population. A stabilizing political situation since the early 2000s and an economic upsurge since the mid-2000s were important factors in the slight increase of the birth and fertility rates and the slight decrease in standardized death rates. In general, Bulgaria lags behind European Union (EU) averages in most mortality and morbidity indicators. Life expectancy at birth reached 73.3 years in 2008 with the main three causes of death being diseases of the circulatory system, malignant neoplasms and diseases of the respiratory system. One of the most important risk factors overall is smoking, and the average standardized death rate for smoking-related causes in 2008 was twice as high as the EU15 average. The Bulgarian health system is characterized by limited statism. The Ministry of Health is responsible for national health policy and the overall organization and functioning of the health system and coordinates with all ministries with relevance to public health. The key players in the insurance system are the insured individuals, the health care providers and the thirdparty payers, comprising the National Health Insurance Fund, the single payer in the social health insurance (SHI) system, and voluntary health insurance companies (VHICs). Health financing consists of a public–private mix. Health care is financed from compulsory health insurance contributions, taxes, out-ofpocket (OOP) payments, voluntary health insurance (VHI) premiums, corporate payments, donations, and external funding. Total health expenditure (THE) as a share of gross domestic product (GDP) increased from 5.3% in 1995 to 7.3% in 2008. At the latter date it consisted of 36.5% OOP payments, 34.8% SHI, 13.6% Ministry of Health expenditure, 9.4% municipality expenditure and 0.3% VHI. Informal payments in the health sector represent a substantial part of total OOP payments (47.1% in 2006).
Dimova, A; Rohova, M; Moutafova, E; Atanasova, E; Koeva, S; Panteli, D and van Ginneken, E & European Observatory on Health Systems and Policies. (2012). Bulgaria: health system review. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/330320
Health Systems in Transition;vol. 14, n. 3
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Health care systems in transition : Bulgaria - 2003 / written by Stayko Koulaksazov ... [et al.] ; edited by Ellie Tragakes Koulaksazov, Stayko; Todorova, Svetla; Tragakes, Ellie; Hristova, Stoyka; World Health Organization. Regional Office for Europe; European Observatory on Health Care Systems (Copenhagen : WHO Regional Office for Europe, 2003)
Georgieva, Lidia; Salchev, Petko; Dimitrova, Rostislava; Dimova, Antoniya; Avdeeva, Olga; World Health Organization. Regional Office for Europe; European Observatory on Health Systems and Policies (Copenhagen : WHO Regional Office for Europe, 2007)
Dimova, A; Rohova, M; Koeva, S; Atanasova, E; Koeva-Dimitrova L; Kostadinova, T and Spranger, A; World Health Organization. Regional Office for Europe; European Observatory on Health Systems and Policies (World Health Organization. Regional Office for Europe, 2018)This analysis of the Bulgarian health system reviews developments in its organization and governance, health financing, health care provision, health reforms and health system performance. With the 2015 National ...