Can people afford to pay for health care? New evidence on financial protection in Bulgaria

ABSTRACT

This review is part of a series of country-based studies generating new evidence on financial protection in European health systems. Financial protection is central to universal health coverage and a core dimension of health system performance. Bulgaria has a high incidence of impoverishing and catastrophic health spending compared to other countries in Europe. Catastrophic spending is almost entirely driven by out-of-pocket payments for outpatient medicines and has increased over time. It is heavily concentrated among poorer households, older people and people living in rural areas, reflecting significant gaps in all three dimensions of health coverage population entitlement, service coverage and user charges (co-payments). Although public spending on health has grown in recent years, it remains low by European Union standards and has not kept pace with growth in out-of-pocket payments or been used to target unmet need and financial hardship. To reduce unmet need and financial hardship, the Government should focus on improving the affordability of outpatient medicines and strengthening protection from out-of-pocket payments for poorer households and people with chronic conditions. This can be done by introducing exemptions from co-payments for these two groups of people; extending the annual cap on co-payments for inpatient care to all co-payments and linking the cap to household income; continuing to improve the way in which the National Health Insurance Fund purchases outpatient medicines; and finding ways to extend health insurance to the whole population.