VISION FOR THE DEVELOPMENT OF HEALTH SERVICES IN BULGARIA UNTIL

THE YEAR 2020

In 2020 Bulgaria should be country guaranteeing its citizens improvement of health and
prosperity and decrease in terms of health-care inequality through a comprehensive and
fair health system providing high quality of services.

MAIN VALUES:
The present concept of “Health Target Goals 2020” is based on values in the constitution of the
WHO and common values and principles related to the management of European health
systems in the countries of the European Union.
Acknowledging the right of every Bulgarian citizen to have high health-care standard, it is an
expression of political will related to bringing a universal reach, solidarity and equal access to
high-quality health services as values associated with the organization and financing of the
health system:
■ Universal reach – provision of access to health services for all citizens;
■ Solidarity – provision of health expenses associated with the potential for payment and
use of services by all people who need these;
■ Equality – equal access to health care in compliance with the needs and regardless of
ethnic origin, gender, age, social status or wealth
■ Access to high-quality care – provision of the highest level of care and with patient
orientation in terms of individual needs and on the basis of ethics and evidence.
The concept reflects the understanding that provision of fairness and equality with regard to
health care, rights and obligations for provision of the highest level of individual and public
health is the main prerequisite for reaching stable development and better quality of life and
prosperity for everybody.
Defending these values will provide the necessary basis for the formation of national health
care policy with orientation towards clear goals and results guaranteeing the rights of every
Bulgarian citizen to have the highest level of health care and prosperity throughout their entire
life.

NATIONAL HEALTH GOALS

On the basis of the population’s health status in Bulgaria, we have specification of the following
national goals until the year 2020:
1. Reduction of mortality rates for children 0-1 years of age – to 6.8 per 1000 born-alive;
2. Reduction of the mortality rate for children from 1-9 years of age – to 0.24 per 1000 children;
3. Reduction of the mortality rate to 0.28 per 1000 in the case of young people 10-19 years old;
4. Increase of the work potential and reduction of mortality rates for persons in economically
active groups 20-65 years old to 4.19 per 1000;
5. Increase of the average longevity of people older than 65 to 16.4 years;
The indicated health goals are directly related to the established problems and negative trends
with regard to the health of Bulgarian citizens and provide opportunity for objective assessment
of the integrated policies for their realization.

HOSPITAL CARE
The study on spending public funds in different countries shows that Bulgaria spends relatively
more funds for hospital services - 52% of its current spending, nearly 20 percentage points
above the proportion intended for hospitals in other countries (Fig. 23).

Fig. 23 State funding for health care in Bulgaria and EU countries

Source: OECD health and Bulgaria NHA

The hospital capacity and the proportion of hospitalizations are above average, even when
comparing Bulgaria with countries of similar levels of income and health care costs. Although
the number of hospital beds per 1,000 people decreased significantly compared with the peak
in the 90s of last century, it remains relatively higher than the European average levels. At the
same time, the number of opened new hospitals is increasing, mainly in the private sector.
 Health for the Bulgarians has always been one of the most
important things in life. The main law of the country – The constitution of Bulgaria
– gives the equal right of healthcare to every citizen. The current healthcare system
is a complex bureaucratic structure that was created during the years of Socialism
(1945-1989) and is still going through deep reforms to meet the modern
standards. After the accession of Bulgaria into the European union in 2007, the
health policies of the Government aim to meet the requirement of the EU. Bulgaria is
in the European region of the World Health Organization and is following the
European policy for health and well-being: “Health 2020”. However, numerous issues
are yet to be solved, including the economical instability of the healthcare system, the
underfunding of hospitals and the unaffordably high prices of medication.

The Ministry of health of Bulgaria

This is the central institution that is responsible for the implementation of the official
government policies throughout the country. The main administrative organ on the
management of the National health system is the Minister of healthcare who is
assigned by the government and is responsible for the control on the activities of all
institutions. A High Medical council, which includes representatives of the National
health insurance fund, all Medical universities and the Bulgarian Red Cross is elected
by the minister. This High council discusses and makes decisions for the national
health strategy, draft legislation, the criteria for the admission of students in medical
universities, scientific priorities in the area of medicine and the annual draft budget for
healthcare. A significant influence on the healthcare in Bulgaria has the Bulgarian
medical association, which was established in 1901 and is the second professional
medical association in the world (after the British Medical association). During some
periods in history, the Bulgarian medical society has even had the functions of a
Ministry of healthcare.
 An excersize of the Bulgarian Red Cross
Regional health inspectorates are responsible for the administration of
district hospitals and the application of the government policies and international
standards locally, control over all medical activities, the provision of statistical
information and also ensure that laws like the ban on smoking in public places are
effectively enforced. There is a health inspectorate in every administrative region of
the country.

Regional Health Inspectorates websites:

Blagoevgrad, Burgas, Dobrich, Gabrovo, Haskovo, Karjali, Kyustendil, Lovech, Mont

ana, Pararjik, Pernik, Pleven, Plovdiv, Razgrad, Ruse, Silistra, Sliven, Smolyan, Sofia
(city), Sofia (region), Shumen, Stara Zagora, Varna, Vidin, Vratsa, Yambol

Medical Universities of Bulgaria

Pharmaceutical faculty of MU Sofia

The main institutions for certification of physicians are the medical universities and
the hospitals that provide traineeship. Some of them have started offering education
in English in recent years and are attracting foreign students because of the lower
taxes and the high quality of the education.

The Medical university of Sofia is the oldest medical university in Bulgaria –

established in 1917, with almost a century of experience in scientific studies, provides
some of the best trained specialists in Europe. The university has four faculties:
Faculty of Medicine, Faculty of Dental medicine, Faculty of Pharmacy and a Faculty
of Public health. It offers education in both English and Bulgarian.

Trakia University – Stara Zagora

Trakia university is a an autonomous state university that was established in 1995 in
Stara Zagora and is focused on Veterinary medicine, but also offers Medicine,
Nursing and Health care management bachelor courses. A program of Veterinary
medicine in English is available – it is a 5.5 year program for a master’s degree and a
3 years for a doctoral degree. The university has a department of Medical physics,
biophysics, rentgenology and radiology.

Plovdiv Medical university

The Medical university of Plovdiv, in the second largest city of Bulgaria, was
established in 1945 as a Medical faculty of the Plovdiv university and five years later,
in 1950, was converted into a medical academy. Today, with over 70 years of
experience, the university offers high education programs in English and Bulgarian in
a Medical, Pharmaceutical, a Public health and Dental medicine faculty.

The Medical university of Varna is a high-tech modern university that was established
in 1960 and offers programs in Medicine, Public health, Pharmacy and Dental
medicine in English, Bulgarian and Romanian. Courses of Bulgarian language are
organized for the foreign students. It has some of the highest results in accreditation,
meaning that provides highest quality of medical education. Since 1997 The medical
college of Varna is affiliated with the Medical university.

Oncological hospitals of Bulgaria

 “St. Mina” hospital in Blagoevgrad
Hospitals specialized in diagnosis and treatment of cancer are found in most larger
cities of Bulgaria. Treatment of cancer and precancerous conditions is done by the
conventional methods of operation, radiotherapy and chemotherapy.

Complex oncological center, Burgas,

Specialized hospital for active oncologic treatment “St. Mina”, Blagoevgrad
Medical oncology department in “Avis Medica”, Pleven
District dispensary for oncological diseases with a stationary, Plovdiv
Oncochematology and Chematology clinic in “St. George” Hospital, Plovdiv
Complex oncological center, Russe
Center for diagnosis and treatment of breast Cancer, “Mamolog”, Russe
“Complex oncology center” LTD – Shumen
Specialized hospital for active treatment in oncology, Sofia
Tokuda Hospital, Sofia
Radiotherapy clinic in “Tsaritsa Yoanna – ISUL” University hospital
National specialized hospital for active treatment of hematologic diseases, Sofia
“Complex oncology center” LTD, Stara Zagora
Clinic of medical oncology “St. Marina”, Varna
Specialized clinic of oncology “Dr. Marko Antonov Markov“, Varna
Clinic of children’s hematology and oncology in”St. Marina”, Varna
Complex Oncology Center, Veliko Tarnovo

Cancer incidence in Bulgaria per district.

Every day in Bulgaria an average of 100 people are diagnosed with cancer (in a
population of 7.2 million). Statistically the most common type of cancer in Bulgaria
is Breast cancer in women with 27.3% of all cases and Lung cancer in men with
18.9% of all cases. By cigarette consumption per capita Bulgaria is ranked third
in the world (after Greece and Serbia). The other most common types of cancer in
Bulgaria, excluding non-melanoma skin cancer, with a percent of all cases are: in
men – Prostate (16.1%), Colon (8.3%), Bladder (7.8%), Rectum and Anus (7.0%); in
women – Corpus Uteri (8.4%), Colon (8.3%), Cervix Uteri (7.5%) and Ovary (5.3%)
cancer.

The incidence of cancer in both men and

women is increasing by 1.5-1.7% a year, but the mortality does not tend to increase.
As shown above, the most common malignancies, except non-melanoma skin
cancer, are lung and breast cancer. Statistically, in Bulgaria the cancer incidence is
367.0 per 100.000 in men and 290.5 per 100.000 women, which is lower than the
European average. However, the mortality in men is higher than the average for the
EU.

Healthcare issues of recent years

A Bulgarian ambulance
The Bulgarian healthcare system is financed by compulsory health insurance taxes
and out of pocket payments. The health insurance payments are calculated at 8% of
the monthly wage of the insured individuals. However the lack of funding for hospitals
is one of the main issues of Bulgarian healthcare, leading to lack of resources for
treatment, incapability of paying hospital debts and even bankruptcy and closure of
the health institutions. On one hand are corruption and the bad practices in some
hospitals of inscribing in the hospital registry more activities than what has actually
been done, and on the other hand is the absence of possibility to raise health care
taxes due to the low wages in the country. The average Bulgarian has almost no trust
in Bulgarian healthcare, while scandals of fraud and incompetence of physicians are
a daily subject in local news.