The entire network of healthcare facilities in Bulgaria, as well as the current healthcare financing model, need to be reviewed, as the existing model is clearly not the best option. While it provides stability, it also perpetuates shortcomings inherited from a previous period. This was stated by Grigor Dimitrov, Chief Director at the Bulgarian Industrial Association (BIA), during the forum “Generic and Biosimilar Medicines – A Guarantee for Sustainable Access to Treatment”. The event was held to mark the 25th anniversary of the Bulgarian Generic Pharmaceutical Association (BGPharmA).
Among the key questions that need to be addressed are whether Bulgaria will continue to operate with a single national health insurance fund; what role the state will play in the coming years, having allowed more than 300 hospitals to operate in the country; what the optimal balance should be between expenditure on generic and innovative medicines; how resources should be allocated between prevention and treatment; and how qualified medical professionals can be encouraged to remain in the healthcare system, Dimitrov added.
According to him, Bulgaria is facing major challenges related to global megatrends shaping society. These include demographic developments, the introduction of artificial intelligence, and social inequalities in terms of income, access to healthcare and access to medicines. He warned that inequalities would deepen in the absence of a robust social policy and could lead to serious social tensions. The postponement of substantial reforms and the lack of a coherent government policy are pushing the healthcare system towards a critical state, Dimitrov added.
Over the past 10 years, the National Health Insurance Fund (NHIF) has received BGN 56 billion, while health insurance payments amounted to BGN 54 billion. The Fund's operating costs stand at approximately BGN 100 million per year, he noted.
During this period, half of the Fund's resources were allocated to hospital care and around 25% to medicines. This means that three-quarters of its available funding is spent on hospital services and medicines, Dimitrov added.
According to him, generic medicines account for 22–24% of the market in the EU, with their share tending to be higher in wealthier countries. In Bulgaria, however, generic medicines account for no more than 7–8% of the market, he said.
Dimitrov also recalled that healthcare expenditure as a share of GDP in Bulgaria is more than twice as low as the EU average, while the country's health insurance contribution rate is also twice as low.
