Bulgaria has a high incidence of catastrophic health expenditures compared to other European countries. A new WHO/Europe report released today in the Bulgarian parliament reveals that in 2018, 1 in 5 households incurred direct payments that exceeded their ability to pay for healthcare by at least 40%. Catastrophic health expenditures can mean that a family can no longer meet other basic needs such as food, housing and electricity.
People who pay out-of-pocket for outpatient medicines are the main driver of catastrophic health expenditures in Bulgaria. This type of spending affects the poorest households, the elderly and people living in rural areas the most, and has increased over time, notes the new report ‘Can people afford health care? New evidence on financial protection in Bulgaria”.
While the country has made progress in some areas, direct payments accounted for 39% of healthcare spending in 2019, well above the European Union (EU) average of 21%, the report says.
“Bulgaria’s heavy reliance on direct payments for health care is a challenge for universal health coverage – the idea that everyone should be able to use quality health services without experiencing financial hardship,” said Tamás Evetovits, head of the office. of the WHO in Barcelona. for Financing Health Systems. “The report recommends focusing on ways to ensure that the National Health Insurance Fund covers the entire population and that it makes exemptions for people who cannot afford co-payments for drugs and other health services.”
“Bulgaria has taken concrete steps to improve access to healthcare and reduce financial hardship for people using healthcare services, but important gaps in healthcare coverage remain, especially for low-income families,” said Antoniya Dimova, Dean of the Faculty of Public Health at Medical University-Varna and lead author of the report.
“This new analysis provides a detailed view of the current situation and identifies a number of options to strengthen financial protection in our healthcare system,” said Anton Tonev, chairman of the Parliamentary Health Committee in Bulgaria.
Gaps in coverage
Reforms introduced over the past 10 years have expanded the range of health benefits provided by the National Health Insurance Fund (NHIF) and aimed to increase the level of government budget funding for the NHIF. To see also : 10 self-help books for women and men with a chronic illness or disability. Despite these positive developments, the report draws attention to persistent gaps in health coverage.
Almost 15% of the population is uninsured and can only access some publicly funded health services. Only those who pay health insurance contributions can access NHIF benefits. The government only pays contributions to people living in extreme poverty; as a result, many low-income people are required to pay contributions but cannot pay.
Copayments are particularly heavy for outpatient prescriptions, there are no exemptions from copayments for many drugs, and there is no general limit on copayments. This is especially harmful because people have to pay part of the price of treatment in Bulgaria through percentage co-payments, and drug prices are high compared to other EU countries.
Making access to health care affordable for everyone
To improve access to healthcare and financial protection, policies should focus on finding ways for the NHIF to cover the entire population. The WHO report emphasizes that penalizing people who cannot pay health insurance contributions by restricting their access to health care undermines progress towards universal health coverage. The report’s recommendations to address this include:
WHO supports countries in moving towards universal health coverage
Financial protection is critical to universal health coverage, which is at the heart of the European Work Program, WHO/Europe’s strategic framework. Through the WHO Office of Financing for Health Systems in Barcelona, WHO/Europe monitors financial protection – affordable access to healthcare – in more than 40 countries. See the article : Myths about abortion and women’s mental health are rife, experts say. Financial protection is an indicator of the Sustainable Development Goals and is part of the European Pillar of Social Rights. The WHO Barcelona Office also provides tailored technical assistance to countries to reduce unmet needs and financial difficulties by identifying and addressing gaps in coverage.
