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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.

 


The Bulgarian Health System has been grossly underfunded during the Communist and post Communist era and the buildings lack any aesthetic surroundings although they do now contains much in the way of modern technology, which in city hospitals is on a par with that offered in the West. The standard of nursing and ancillary care varies between institutions and in some cases relatives are expected to provide food for the sick family member as well as spending long periods in the hospital arranging bedding. All medication must be paid for and in some instances you will be asked to collect a prescription for you relative from a nearby pharmacy.

There are also 30 specialist hospitals located across the country – some specialise in the treatment of particular diseases whilst others cater for patients in need of rehabilitation – the thing to remember is that such hospitals may be located hundreds of miles from your home town, but they are well equipped to deal with ease with their areas of speciality.

Each hospital has an Accident and Emergency department, which treats all emergency cases in one area. Emergencies are admitted without a doctor’s referral to the closest hospital until their condition is stabilised or until they can be transferred to a hospital that caters for their injury or illness. Foreign visitors and expats can attend the A&E using their EHIC cards in conjunction with their passports. If you need to call an ambulance dial 112, the EU emergency number.  Bear in mind that sometimes it may be faster to take a taxi.

It is worth noting that Bulgarian pharmacies are often the first point of call for those with minor ailments and injuries. It is only recently that pharmacies known as Apteka became regulated by the government. Prior to 2007 they were often manned by non-qualified personnel, however today all pharmacists must be qualified to prescribe drugs. Pharmacies can sell many drugs over the counter, which are not permitted for sale without a prescription in the West, medicines like antibiotics without a prescription.

Healthcare for Short Term Foreign Visitors

All states within the European Union have a reciprocal health agreement with Bulgaria and this also includes those non-EU members who are part of the European Economic Area, namely Norway, Switzerland, Iceland and Liechtenstein. Some of Bulgaria’s neighbouring countries and former CIS country members also have reciprocal medical agreements. Those citizens who do not hold a passport from a country in these groups must ensure that they have private medical insurance to cover their stay in Bulgaria.

If you are an EU citizen, you should ensure that you apply for a European Health Insurance Card (EHIC). This allows you to receive free medical treatment for any injury or illness that occurs during your stay here. This treatment can only be given in state institutions and any treatment within a private clinic must be paid for accordingly. The card also provides treatment for ongoing chronic disease and illness as well as routine maternity examinations. If you need treatment like oxygen therapy or kidney dialysis whilst you are visiting the country, you have to arrange this in advance.

You must be sure that your illness or injury is deemed significant and has happened during your stay, otherwise you will be asked to pay private medical fees. Backache or a sprained wrist is not considered a medical emergency no matter how painful, unless it turns out to be broken or part of a larger life threatening problem.

The World Health Organisation does not recommend any vaccinations for visitors to Bulgaria, but some medics recommend that those staying outside of the tourist resorts ensure that they are vaccinated against tetanus, typhoid and hepatitis A, hepatitis B, tick-borne encephalitis and rabies.

The decision to immunise against these is an individual one and most people do not bother.

Bulgaria’s abundance of mineral springs mean that its tap water is safe to drink although the water is chlorinated and some visitors experience mild stomach upset because of this.

 

Health Care Within the Resorts

Within Bulgaria’s many holiday resorts there is a wide range of medical care on offer – everything from physiotherapy to dental care. Visitors should be aware that these facilities are all private practices and are limited in the injuries and illnesses they can treat – they also charge extremely high fees and do not accept the EHIC card. Fees in excess of 100 lv. are charged for treating a bout of ‘flu, when the local chemist could have provided medicine to cure the common cold at a fraction of the price. Visitors who run to their hotel reception desk for help with an ailment or injury are likely to find themselves transported by ambulance to the nearest private clinic. It is wise to refuse an ambulance if you can make your own way there as the cost is in the region of 200 lv. for journeys as short as two minutes!