Cancer treatment is a priority in both Bulgaria and the UK, but there have been suggestions that cancer care in both countries lags behind that of other European nations. Macmillan Cancer Support, the UK’s main cancer charity, notes that survival rates are not as strong in the UK as elsewhere in Europe, and a country profile report from the EC highlights issues with the overall quality of healthcare in Bulgaria.Your access to oncological treatment will depend to some extent on whether you are accessing the public or private health sectors. Both countries have two-tier health insurance systems.
In the UK, national health insurance cover (the NHS) extends to all citizens and is free at the point of delivery: it is paid for out of contributions deducted from salaries. As an expat into the UK, you may need to pay a surcharge.
In Bulgaria, state health insurance is mandatory for employed expats and you will be able to pay into the national scheme (NOI), thus becoming eligible for reductions or free at the point of delivery treatment.
Oncological treatment in the UK
If you are an expat living in the UK, and you need to undergo oncological treatment, you will need to have resident status in order to qualify for treatment. However, if you are coming from outside an EU member state, and you are intending to remain in the UK for more than six months but not planning to move here permanently, you may be required to pay a surcharge (the Immigration Health Surcharge or IHS) at the time of your visa application. The NHS website says that if you are coming to the UK for a temporary stay of more than six months, you may be required to pay an immigration health surcharge at the time of your visa application. The standard surcharge fee is:
• £300 per year per person for students and each of their dependents
• £400 per year per person for everyone else
The full amount will need to be paid upfront for the duration of your visa.
There are circumstances when you do not have to pay the surcharge, such as if you are the dependent of a member of the forces who is not subject to immigration control.
If you are diagnosed with cancer, and are eligible for treatment, you will be fast-tracked by the NHS into your local oncology department and a course of treatment will be outlined for you by the oncology team. This may consist of surgery, radiotherapy and/or chemotherapy, and possibly immunotherapy depending on the type of cancer that you have.
You will not need to pay out-of-pocket for any treatment that you receive, including any stays in hospital. Oncological treatment under the NHS involves follow-ups, too: you will have check-ups with your consultant on a regular basis (e.g. three monthly, followed by six monthly and annual check-ups) after your treatment has finished.
Taking out private health insurance will not make a great difference to the quality of your cancer treatment in the UK: private and public patients alike will receive the same levels of medical care. Nor will private insurance necessarily speed up your access to treatment, since the NHS tends to place a high priority on cancer patients. However, private cover will give you more comfortable facilities; for example, a private room in a hospital.
Oncological treatment in Bulgaria
In Bulgaria, life expectancy is below the EU average, at 76 for women and under 70 for men: in part a legacy of poor healthcare management when Bulgaria was still part of the Soviet bloc. According to the WHO, the highest causes of death are cancer and circulatory diseases: deaths from the latter are the highest in the EU, comprising 4/5 of deaths, and reductions of the mortality rate due to cancer are also lower than elsewhere in Europe.
Bulgaria has a long history of state healthcare, with the second oldest medical association in the world, after Britain. Public healthcare is now funded by compulsory health insurance contributions, taxes, and out-of-pocket payments, in addition to voluntary health insurance premiums, corporate payments, donations and other funding. In the big urban areas, public healthcare is of a reasonably high standard but you might find relics of the Soviet system in more rural regions, and there is often a shortage of medical personnel once you get out of the cities.
Sofia, Plovdiv and Trakia, among others, have university hospitals which undertake cutting-edge research. A part-Bulgarian cancer research team recently revealed the dynamics of 70 key proteins involved in DNA repair, for instance. Sofia, Burgas and other cities have specialist centres for oncological care.
Since 2011, cancer screenings have been covered under the national insurance scheme: for example, a prostate-specific antigen prostate cancer test for men over 50 years of age and breast mammography screening for women over 50 every two years.
If the hospital is part of the NHIF, your actual treatment will be free at the point of delivery. Once you have been discharged from hospital, you will be entitled to a maximum of two examinations as part of your inpatient care. The minimum daily charge for hospital stays with providers which are contracted with the NHIF is BGN 5.80 for up to 10 days.
You should be told about any additional costs you may have to cover yourself, but check this with the provider on admittance, if possible. You should also be able to request a specific medical team, a private room or personal assistance upon the payment of an additional charge.
However, it has been claimed that the average Bulgarian has no confidence in public healthcare. Corruption, underfunding and bad practices have eroded the reputation of the Bulgarian healthcare system and this is why many expats choose to take out private health insurance. There are reports of Bulgarian citizens travelling to Turkey in order to seek cancer treatment, with a perception that it will be cheaper and of a higher quality.
The level of cancer treatment that you receive will depend on whether you’re using the public or private sectors: the quality of private treatment is relatively equal between the two countries. However, if you are using the state sector, you will be better off in the UK, with no additional hospital charges beyond the initial surcharge, and more modern facilities overall, particularly in the regions: unlike Bulgaria, rural hospitals in the UK are modern and of a high standard.
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