site.btaHealthcare Inflation in Bulgaria Twice National Average, Analysis Shows

Healthcare inflation in Bulgaria in 2026 compared to 2025 is double that of the country, shows an analysis of the health insurance system in Bulgaria presented at Bulgarian News Agency's National Press Club on Tuesday. It was carried out by Health Metrics - a company specializing in the collection, analysis and presentation of health, social and economic information. The analysis proposes measures to increase revenues in the National Health Insurance Fund (NHIF) budget for 2026-2027.

Health Metrics expert Ekaterina Illarionova said that nearly half of the workers in Bulgaria are over 45 years of age, and this is an age above which the incidence of chronic diseases increases sharply. She added that Bulgaria is among the fastest aging countries in the EU, and preventable mortality in the country remains among the highest among EU countries. The main problems facing the NHIF are the growing demographic pressure, a limited revenue base (11-12% of the population is not health insured) and rising healthcare costs. According to Illarionova, there is a rapid increase in funds for hospital care instead of prevention.

The share of co-payments by citizens is more than double compared to co-payments in other EU countries, said Health Metrics healthcare macroeconomist Arkadi Sharkov. Within five years, household healthcare costs have increased by 60%, with Bulgaria ranking first in the EU in terms of co-payments by households. Nearly 77% of co-payments by Bulgarian patients are for medicines, including those partially reimbursed by the health fund, he added.

Sharkov said that for the period 2022-2025, discounts to the NHIF provided by pharmaceutical companies have increased by nearly 115%, adding that pharmaceutical companies often hesitate whether to leave a certain medicinal product on the Bulgarian market. Drug prices in Bulgaria are determined according to strict criteria and in comparison with prices in 10 EU countries, with the lowest price being chosen for the country, Sharkov pointed out.

Health Metrics proposed to update the health insurance contribution – from 8% to 10%, and to pay it in full for the groups of citizens who are insured by the State, to reduce the number of uninsured persons, to ensure targeted transfers from excise taxes on goods harmful to health, to have a guaranteed minimum growth of funds for health insurance payments of at least 10% per year, to have a proportional growth of drug budgets compared to the total growth of the budget for health insurance payments. The expected effects are higher financial sustainability of the NHIF, reduction of hidden deficits, better predictability, improved financial protection for households and more efficient use of resources in the system.

Sharkov stated that the imposition of duties by the US on drugs has a direct effect and will have a direct effect on their prices in Europe. According to him, if there is no coordinated health policy that takes into account macroeconomic realities, "Europe risks permanently falling behind in the global biotechnology race. The decline in traffic through the Strait of Hormuz has led to a 95% drop in supplies of some drugs in the UK, and this factor is expected to lead to a drop in supplies on the entire European market," Sharkov added.