Bulgaria Health Financing : Final Report on Health Financing Diagnostic and Review of Envisaged Reforms

Abstract

Health financing in Bulgaria is organized in a way that should, in theory, allow the system to deliver good performance. In particular, the national health insurance fund was set up to provide universal coverage, and the provider-payment system contains elements of international best practices. The hospital-centric service delivery structure is not well targeted to the predominant and growing burden of non-communicable diseases, and loopholes in the provider-payment system reinforce this bias toward expensive hospital care. The first part of this report presents a health financing diagnostic to assist the Government of Bulgaria in developing health financing reform options that improve the efficiency, equity, and long-term sustainability of the Bulgarian health system. The second part reviews the reform agenda currently envisaged by the government with a focus on health financing aspects. It presents practical suggestions, drawn from international experience, which should support the government as it moves toward implementing its reform agenda. These suggestions aim to enhance the reforms' capacity to address some of the performance gaps highlighted in part one with respect to efficiency, sustainability, and capacity to provide financial protection.