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Bulgaria - Health Service
Bulgarian nationals are entitled to free or subsidised state medical care from a doctor, free referrals to a specialist, reduced price medicines and dental treatment. All Bulgarians have a National Insurance number which entitles them to use the state healthcare system, and employers are usually responsible for enrolling employees into the health insurance fund. Fees are split between the employer and the employee and they are directly taken from employees’ salaries to the Bulgarian social security (NOI). Contributions from working people are around 15 BGN per month. The figure is determined each year by the Bulgarian parliament which determines the budget for the National Health fund. Self-employed persons are obliged to pay the entire contribution themselves. Dependant family members are covered by the employed family member, meaning higher rates of contribution in this case.
The unemployed, the poor, pensioners, students, soldiers, civil servants and other vulnerable categories, like the Roma population, are exempt from payment. Registered foreign residents must also contribute to the Bulgarian national insurance fund regardless of whether they are employed or not. Otherwise they can consider private healthcare. It is not uncommon that Bulgarian hospitals treat foreign residents who hold European Health Identity Cards under this reciprocal scheme, while foreigners from EU member states are required to provide copies of their EHIC once they register.
The standard of private healthcare in Bulgaria is considered to be higher than public healthcare, but this is reflected in the fees that private practitioners charge. The system for reimbursement of private medical charges is time-consuming as well. Many foreigners come to Bulgaria to take advantage of the private healthcare system, which is considered much cheaper than in some Western European countries.
Most small towns in Bulgaria have at least one doctor that is always available but patients can also register with a doctor of their choice in any town. Doctors are responsible for referring patients to specialists and hospitals. However, they are not well trained in general practice and tend to make referrals to specialists or hospitals. Patients who visit specialists without a referral have to pay for any services provided. Some employers have their own clinics that employ a GP to serve the medical needs within the company. Under-the-table payments can occur, especially within the expat population, although membership of the EU has meant that such practices are being addressed.
Polyclinics were also included in the previous Bulgarian healthcare system, but when the new system was adopted, their function changed. The name "Polyclinic" can still be found on many former polyclinic buildings. Today, they provide specialist diagnostic and consultation centres for outpatient care. They are owned by the municipalities that govern each region. Some polyclinics offer only specialist outpatient care and are staffed by consultants who are specialists in a particular field of medicine. Some are attached to companies and others are open to the general population. Some of them offer dental services.
Hospitals and clinics can be found in all major towns and cities in Bulgaria, but those who want to access them from remote villages can find it quite challenging. Bulgaria has 30 specialist hospitals, which include hospitals for active treatment care for patients with acute diseases, cosmetic and surgical operations and obstetrics. On the other hand, hospitals for completion of treatment take care of the people who need rehabilitation or long term care. Rehabilitation care hospitals offer services to patients who need treatment like physiotherapy.
The best-qualified medical staff are employed in urban areas. Facilities in the majority of Bulgarian hospitals are in an adequate state. However, the health service has been poorly funded in recent years, so many hospitals still need some repairs. There is also a quite low ratio of nurses and consequently, general nursing duties such as changing sheets and administering meals sometimes have to be done by the family members of the patient.
Patients can be admitted to hospital only after a doctor or specialist referral. If going to the hospital without a referral, patients can only be admitted if the hospital has assessed whether they really need hospital care and if it is deemed necessary. Otherwise, patients must pay for their care themselves. There are various types of hospitals in Bulgaria and doctors tend to send patients to those that are best for their needs regardless of hospital's location in the country. This way, patients can often end up hundreds of miles away from home for prolonged periods.
Emergency cases are usually taken care of in the nearest medical institution until the patient's condition is brought under control or until they are transferred to another hospital.
Until recently, pharmacies, known as Apteka, were not regulated by the state, so it was possible to buy a wide range of drugs over the counter, including antibiotics. Since 2007, qualified pharmacists must run pharmacies, but it is still possible to obtain medicines which are usually reserved for prescription in other countries, directly from the pharmacist.
Many doctors and dentists turned private with the introduction of the free market following the fall of communism in the early 1990s, leading to a huge development of private practices. This meant that clinics had to invest in better technology and provide better staff training and service in order to be competitive in the new Bulgarian market. At the same time, a low wage economy forced them to keep their prices down. It means that today there is a well-equipped private sector for medical work, cosmetic surgery and cosmetic dental surgery, with low prices compared to other European countries. For example breast enhancement surgery usually costs no more than €2,500 and a face lift is around €1,200. Bulgarian dental prices are quite low, with initial treatments as low as €10.
Useful information can found on the official website of the Bulgarian Ministry of Health.
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