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Finding your Way through the Health System

Bulgaria’s doctors and nurses are well trained and are not hampered in delivering first class medical care by the poor standard of the facilities that they must work in. The National Health Service is available to all nationals and is presided over by the Ministry of Health who is responsible for the services overall policies.

Administration of the system is carried out by Regional Health Centres who cover the country’s 28 administrative districts. Everyone who works in Bulgaria including expatriates pays obligatory health insurance contributions.

Bulgaria’s private health system is often staffed by doctors from the state sector and whilst private clinics and hospitals offer more modern and pleasant environments, they do not necessarily offer better quality care. Private medical fees are extremely high in comparison to private fees for state medical treatment and the system for the reimbursement of private fees is complex as well as time-consuming. In comparison to private fees in Western Europe, Bulgaria’s private health system is comparatively cheap.

How the System Works

Bulgarian nationals can claim free or subsidised treatment from doctors, dentists and specialists providing they pay national insurance or qualify for state aided benefits.

Medical care for all Bulgarian children is free. Expats need to enrol into the state healthcare system and pay national insurance contributions to qualify for the same benefits otherwise they are forced to pay for all of their treatment as though they were private clients. You do not need to have a job in Bulgaria to join the state system as you can pay voluntary contributions for yourself and your spouse and such contributions will cover any dependent family members.

If you are employed on a full or part time contract, your employer is responsible for enrolling you into the state health care system. Contributions are paid jointly at source by the employer and the employee and they amount to 8% of their monthly income. The self employed must pay the full contribution directly to the Bulgarian Social Security System known as the NOI.

The Bulgarian parliament analyses what the level of contribution should be on an annual basis and this goes some way to determining the country’s health budget. Those Bulgarian nationals who are either pensioners, unemployed, on low incomes, civil servants, military personnel or students do not have to make any contributions, but this rule does not apply to anyone who is not deemed a Bulgarian national.

If you do not wish to contribute to the Bulgarian state fund, then you can take out private medical insurance. Pensioners and their immediate dependants from EU member states will qualify for subsidised and in some cases free healthcare providing they notify their home country’s health authority as soon as they decide to immigrate to Bulgaria. Foreign residents holding a European Health Identity Card will be treated under this scheme only in emergency situations.

The Structure of the Health System

Both nationals and expats can register with the doctor of their choice and most opt for one close to home or one that speaks their language. All small towns have a doctor, but villages tend to rely on services from the nearest town. In Bulgaria the doctor’s role is to diagnose, treat, prescribe and refer patients to other institutions or professionals in the system. Many GP’s specialised during their medical training and some of the older doctors are not as well versed in general practice as those coming through medical school in the last ten years, this does not mean that their skills are lacking but they do tend to avoid making referrals to specialists and it is often left up to the patient to demand a referral. Nowadays some GPs speak some English, German or Russian. If you visit hospital or a consultant doctor without a referral you will incur fees for any treatment given. If you are employed in a large corporation in Bulgaria, you may find that your employer provides medical care in the work place. Doctors in Bulgaria are paid low salaries and are not averse to taking an “under-the-table payment” to speed up treatment or to prescribe a drug requested by the patient. The best thing to do is not to ask the doctor, “How much?” after your treatment as this always elicits a response!

Bulgaria retains a system of Polyclinics, which are more a legacy of the Communist system. Polyclinics provide facilities for outpatient care like diagnostics and consultations. Some of the polyclinics only provide consultations by specialist doctors on an outpatient basis, whilst others now provide some inpatient care for minor illness and injury. Many of the polyclinics also have their own dentist and optician on site.

Most large towns and cities in Bulgaria have at least one general hospital, but it is worth noting that access to them can be difficult if you live in a remote village community, where poor roads and lighting may hinder access to an ambulance.