Bulgaria is an East Balkan country bordering Romania to the north, Serbia and North Macedonia to the west, Greece and Turkey to the south and Black Sea to the east. Bulgaria has been a member of the European union since 2007 and is classified by the World Bank as a middle-income economy. Bulgaria is a democratic republic with legislative power represented by a Parliament. The official language is Bulgarian; however there is a significant Turkish speaking minority.

Healthcare budget

$4.2 billion


6.9 million

GDP per capita



BGN (1 BGN = 0,51 euro)

World Ranking

GDP 68st

Statistics as April 21st 2021

Bulgaria Healthcare

Bulgaria’s Social Health Insurance system is highly centralized. The Ministry of Health is responsible for overall organisation and policy formulation, while the National Health Insurance Fund (NHIF) is the core purchaser in the system. By law, all citizens are required to obtain insurance and have a right to access care. In Bulgaria, the healthcare expenditures per capita do not reach EUR 1 000, which is less than half the EU average (EUR 2 797). Roughly half of total health expenditure is publicly financed, and the country has exceptionally high out-of-pocket payments – 48%. This is significantly above the EU average of 15% with more than 40 % of out-of-pocket payments being spent on pharmaceuticals, the highest percentage in the EU. The healthcare system is based on the compulsory social insurance model, financed through income-related contributions, taxes and out-of- pocket payments.

Bulgaria’s pharmaceutical environment

Patients have free choice of healthcare provider – GPs, specialists, and hospitals. However, GPs act as gatekeepers to specialty care and to access this the patient must first get a GP referral - specialty care is provided mainly through public and private health centres. There are 25 university hospitals and 354 specialized and regional public and private hospitals. VAT at the level of 20% is applicable for healthcare services and medicines. Further penetration of new innovative therapies that have been launched over the last 2-3 years is expected.

In 2021 the Bulgarian pharmaceutical market will be worth close to 1,9 billion euro.

Today’s challenges

  • Continuous underfinancing of healthcare with limited dedicated public expenditure (4,6% of GDP vs. 7.2% 1in EU).

  • Aging population and life expectancy at 74.7 years - 6 years below EU average.

Patients have free choice of healthcare provider – GP, specialists, and hospitals. Nevertheless, access to health services remains a problem. Some 12% of citizens are without insurance and high out-of-pocket payments threaten access to health care for vulnerable groups, including the Roma, lower income households, and older people. Travel distance and availability of doctors also pose important access barriers, especially for people in lower income groups.

The expert in Bulgaria

Jiri Hermanek

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