site.btaUPDATED Parliamentary Committee on Health Adopts 2026 Health Insurance Budget Bill

The Parliamentary Committee on Health Tuesday approved the draft budget of the National Health Insurance Fund (NHIF) for 2026 with 11 votes in favor, nine against, and no abstentions.

The bill envisages EUR 5,571,998,400 in revenues and transfers to the NHIF budget next year. Revenues alone are projected at EUR 5,196,424,800, including EUR 3,177,034,800 in health insurance contributions and EUR 2,019,390,000 in transfers for health insurance.

Expenditures will total EUR 5,571,998,400 (equalling revenues plus transfers).

The revenue and expenditure sides of the NHIF budget for 2026 are both increasing by EUR 727,652,900, or 15%, compared with the budget for 2025.

On the expenditure side, health insurance payments are set at EUR 4,985,168,900, increasing by EUR 448,026,700, or 9.9%, from last year.

A new item in the annual scheme is an EUR 260 million allocation from the state budget, which will be used to pay for activities of medical treatment facilities under Article 80b, Paragraph 1 of the Medical Treatment Facilities Act.

In 2026, the Health Ministry will transfer EUR 98,717,500 to the NHIF budget in monthly installments intended to pay for activities beyond the scope of compulsory health insurance.

The 2026 NHIF Budget Bill has been compiled in keeping with the budgetary framework, based on the assumption that the health insurance contribution rate will remain at the current 8%. The proposed budget parameters will create a stable financial framework for the functioning of the health insurance system, the government says. 

Here is a takeaway from the comments by professional and employer organizations, the unions and political parties:

Dimitar Marinov, Chairman of the Bulgarian Pharmaceutical Union expressed support for the targeted funding for pharmacies in remote areas but noted that the budget did not increase funding for this mechanism. He warned that introducing minimum guaranteed salaries for pharmacists without specialization lacked guarantees that funds would go to hospital staff and that there were no penalties for hospitals that failed to comply. He supported the budget proposal but suggested it needed revision between the first and second readings.

Dr. Ivan Madzharov, Vice-Chairman of the Bulgarian Medical Association, expressed concern about how funds for hospital staff salaries would be spent. He also argued that specializing medics working with general practitioners should have received salary increases similar to those for hospital-based residents.

Valeri Apostolov of the Podkrepa Labour Confederation noted that the budget did not address key challenges such as the growing number of health facilities, lack of qualified staff, and concentration of services in large cities. He called for a 13.6% salary increase to compensate for inflation and past low raises and supported keeping the health insurance contribution at 8%.

Svilena Dimitrova, Chairman of the Bulgarian Hospital Association, pointed out that the budget increase was smaller than in previous years and likely insufficient, partly due to inflation. She stressed the lack of certainty about raising clinical pathway prices, which were tied to hospital staff salaries, and emphasized that the planned €260 million for medical staff should have been delivered through clinical pathways.

Maria Mincheva, Deputy Chair of the Bulgarian Chamber of Commerce and Industry, said the Chamber did not support the NHIF budget, arguing that the proposed salary increases were flawed and would not reach staff. She opposed earmarked contributions via the National Framework Agreement for salaries and stressed that salary calculations for other medical specialists were missing, risking tension in hospitals.

Vanya Grigorova, Chair of the Health Committee in the Sofia Municipal Council, warned that increasing salaries only for certain medical specialists would create conflicts. She argued that signing a Collective Labor Agreement (CLA) was the only fair way to raise wages.

Georgi Georgiev MP (Vazrazhdane) said his party would not support the draft budget and questioned the NHIF deficit at year-end.

Alexander Simidchiev MP (Continue the Change – Democratic Bulgaria) said he could not fully support the budget, citing insufficient data on population health and uneven growth between outpatient and hospital care funding. He also criticized the mechanism for minimum medical salaries, noting it was unclear if funds would reach the intended staff.

Vasil Pandov MP (Continue the Change – Democratic Bulgaria) criticized the budget for prioritizing hospital care over outpatient prevention and for lacking control mechanisms and reforms. He noted that the €260 million for staff salaries was no longer earmarked and argued that clinical pathways did not guarantee fair pay.

Kostadin Angelov MP (GERB – UDF) said his group would propose amendments so that the planned EUR 260 million would be used solely for salaries to healthcare professionals as per the Health Facilities Act.

Hasan Ademov MP (Alliance for Rights and Freedoms) said that annual billion-leva increases did not solve any problems and even created new ones. He called for an analysis of the volumes in outpatient and hospital care and did not support the budget as it stood.

Andrey Chorbanov MP (There Is Such a People) said the budget structure favored hospitals over prevention programmes, contributing to high mortality rates. He supported establishing minimum wage thresholds for doctors and nursing staff as a regulatory measure.