site.btaForum on Healthcare Held in Sofia

A forum on healthcare, organized by the Bulgarian Medical Union, was held in Sofia on Wednesday, bringing together representatives of medical institutions and community to discuss key challenges and future policies in the system. 

The participants in the forum included President Iliana Iotova, caretaker Health Minister Michail Okoliyski, Parliamentary Health Committee Chair Kostadin Angelov, Bulgarian Medical Union (BMU) Chair Nikolay Branzalov, BMU Vice-Chair Ivan Madzharov, National Health Insurance Fund (NHIF) Governor Petko Stefanovski, and sociologist Dimitar Ganev, who presented data from a nationally representative survey by Trend Research Center.

Addressing the forum, Iotova said that healthcare should unite society and become a national ambition. She noted that there is much to be discussed with medical professionals such as salaries, access to modern technologies, and career development opportunities. According to her, issues that have been unresolved for years are now leading to 35% co-payment for medical services by the patient. This, in her words, is a topic that is worth taking urgent measures on.

Okoliyski said that the current challenges in the healthcare system, in addition to staffing shortages, include ensuring access to quality medical care and timely prevention. "Health is not a one-sided sectoral policy, but a prerequisite for economic development and quality of life, and therefore it should be considered one of the state’s top priorities," he added.

Ganev presented survey data showing that trust in Bulgaria’s healthcare system is highest in general practitioners and specialists (80%), but remains low in institutions, particularly the NHIF and the Health Ministry. A significant share of respondents believe NHIF coverage does not meet patients’ needs, and nearly one quarter have postponed medical care due to financial constraints. The findings highlight widespread out-of-pocket payments, especially for medicines and doctor visits, while most respondents lack supplementary insurance. Key concerns include corruption, staff shortages and poor management, alongside demand for better coverage of diagnostics, prevention and treatments. Strong support was also expressed for mandatory medical training and greater patient involvement in monitoring healthcare services.

Angelov said the healthcare system has lost direction after years of reforms and is failing to deliver its main outcome - health. Citing survey data, he argued the system is not functioning properly and is often used by politicians for short-term gains instead of long-term solutions. Angelov pointed to Bulgaria’s low life expectancy and high childhood obesity rates as evidence of systemic failure. He highlighted out-of-pocket payments as a major issue and called for clear solutions, political consensus, and greater reliance on expert and scientific input in shaping healthcare policies.

Branzalov said that in order for innovations and a higher level of prevention to enter, investments are required. New technologies are being introduced intensively and there are very few systems that can keep up with this rapid growth of medical science, he said. According to Branzalov, the BMU conducted the survey to see what the public thinks about the healthcare system and for political decisions to be made. He said that the most important thing for those who will make the political decisions is to "synchronize their watches" with the public. The message to politicians is that the healthcare system is chronically and severely underfunded, he added.

Stefanovski said that the activities paid for by the NHIF are a matter of political decision. "Everything in the healthcare system depends on politicians," he noted. Stefanovski recalled that a "NHIF for You" campaign has been organized, which aims to explain the health insurance rights of citizens and the activities that the Fund pays for. He also said that the NHIF does not have a budget for 2026, recalling that the MPs passed on second reading the 2025 Budget Extension Act. According to him, if there had been a budget for this year, new prices and activities agreed with the professional organizations of medical professionals and dentists would have been in force. 

Madzharov said that if all political parties are asked, they would say their strategic goals include early diagnosis, prevention, accessible healthcare and addressing staff shortages. He noted that in a 2018 survey, 9% of respondents said they were uninsured, compared to just 5% in 2026, while every second respondent in both surveys did not know the amount they pay for health insurance. Only 2% had supplementary health insurance in 2018, compared to over 10% now, he added. Madzharov also pointed out that out-of-pocket payments by patients for medicines have nearly doubled between 2018 and 2026.

Continue the Change - Democratic Bulgaria MP Alexander Simidchiev emphasized that doctors and teachers must receive decent pay, and the state should not assume that solutions from 20 years ago will be effective for the next 20. "Medicine is not the same as it was 10 years ago - it evolves every two months," he said. According to him, medicine is currently taught the same way it was 50 years ago. "We need new, creative, science-based solutions, science-based approaches, and standards to ensure development across the entire healthcare system," Simidchiev added.

BSP - United Left MP Ilian Iontchev said that Bulgaria must move away from the commercial model of providing medical care in state and municipal hospitals and create a model that private hospitals can also follow. He added that if doctors’ salaries are raised to provide them with peace of mind and a decent standard of living, this will automatically reduce the perception of corruption. “The salaries of a large number of doctors are truly inadequate,” Iontchev stressed.