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Healthcare in Bulgaria

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.

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

Medical Universities of Bulgaria

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  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.

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

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

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

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.

References:

1. Cancer incidence in Bulgaria – 2011, Vol. XXII, 2013 

2.Health Systems in Transition. Bulgaria – Health system review

3. National Health Strategy 2020, first draft , Health 2020