site.btaPartners Split on Health Insurance Fund Budget: One Employer Organization Opposes, One Trade Union Abstains

The National Council for Tripartite Cooperation, bringing together the government, employers and trade unions, examined the 2026 National Health Insurance Fund (NHIF) Budget Bill on Monday. The Bulgarian Industrial Capital Association (BICA) did not support the proposal, while the Confederation of Independent Trade Unions in Bulgaria (CITUB) abstained.

On Sunday, the NHIF Supervisory Board approved the Budget Bill.

According to NHIF Governor Petko Stefanovski, the NHIF Budget Bill was drawn up in line with the parameters and assumptions of the consolidated general budget framework, including changes to specific indicators. Revenues, including transfers, are projected at EUR 5,288,592,000, which is EUR 444 million more for healthcare compared with 2025, up by 9.2%.

The NHIF Budget Bill envisages a 6.4% increase in funding for primary outpatient care, a 4.7% rise for specialized outpatient care, a 9.5% increase for medical diagnostic activities, a 10.1% rise for hospital care, a 5.7% increase for medical devices, and a 10.2% increase for medicines, medical devices and dietary foods for home treatment, said Stefanovski.

Also, EUR 40 million are planned for the creation of an electronic health card system, which will give general practitioners and emergency doctors and specialists access to patients' records. The system will also ensure verification of every medical activity.

The NHIF reserve is set at EUR 155,193,000, up by more than 9.3% from 2025.

The Health Ministry supports the 2026 NHIF Budget Bill, Minister Silvi Kirilov said. According to him, the draft budget reflects the proposals submitted by the Ministry. The projected revenues and transfers provide a stable financial framework for health insurance payments. The 9.2% increase in expenditure compared with this year's funding will enable the normal financing of the package of medical activities guaranteed by the NHIF budget, as well as a balanced allocation of health insurance funds across categories, Kirilov said.

The parameters of the NHIF Budget Bill create a stable financial framework for the functioning of the healthcare system, said Yavor Penchev, Chair of the NHIF Supervisory Board.

The Finance Ministry supports the NHIF Budget Bill, Finance Minister Temenuzhka Petkova said.

Rumen Radev, Governing Board Chairman of the Bulgarian Industrial Capital Association (BICA), said: "This budget follows the pattern of all previous NHIF budgets, and we traditionally do not support it, because the expenditure side for hospitals and medicines continues to dominate overwhelmingly, whereas its philosophy should be precisely the opposite - to increase funding for prevention."

Maria Mincheva, Deputy Chair of the Bulgarian Chamber of Commerce and Industry, stressed that a systemic approach is needed to address problems in the sector, noting that next year will be the right time to take a comprehensive look at solutions for both the healthcare and pension systems. She said: "It is important to ensure stability in the system and to guarantee payments over the next few months. We welcome the removal of EUR 260 million from the Bill, because we believe this was a flawed approach. It would not have solved people's problems; there were no calculations on how many people were concerned, how their gross salaries would change, and it would have created a much bigger problem," she added.

The first version of the NHIF Budget Bill included a EUR 260 million transfer from the central government budget for the salaries of medical staff in healthcare facilities. In the current version, funding for young doctors is included in the Health Ministry's budget, allocated through a different mechanism and in a different amount.

Tsvetan Simeonov, President of the Bulgarian Chamber of Commerce and Industry, backed the budget, albeit with reservations, noting that efforts had been made to improve it.

The Confederation of Employers and Industrialists in Bulgaria also expressed support for the NHIF budget proposal, noting that it is far more secure for young doctors without a specialty to receive their pay through the Health Ministry, where such funds can be budgeted predictably each year.

The Confederation of Independent Trade Unions in Bulgaria (CITUB) abstained from supporting the NHIF Budget Bill. The union voiced concern that funding was reduced by EUR 208 million. CITUB President Plamen Dimitrov said that although the Health Ministry's budget sees an increase, this does not solve the systemic issue affecting doctors and nurses. "We do not see solutions in this NHIF budget that would address the problem of staff shortages sustainably," he said.

The Podkrepa Confederation of Labour is supportive of the proposed NHIF budget. Podkrepa President Dimitar Manolov acknowledged that "this budget has its shortcomings, but it could have been far worse". He said: "The issue of salaries is fundamental, yet it is not addressed by the current financing mechanism. This hinders the development of a sustainable policy, which puts at risk the accessibility of our health insurance system." Strategic discussions need to begin, since they have been postponed in every previous budget cycle, said Manolov.