Editing Healthcare System (Bulgaria)

[[dct:title::Bulgaria]] has a mandatory social health insurance (SHI) system with a minor role for voluntary health insurance (VHI). Although the law mandates universal health coverage, approximately 12% of the population is uninsured, with the long-term unemployed, the Roma community, and individuals in disadvantaged regions being most affected.

The Bulgarian Ministry of Health is in charge of regulating and coordinating the healthcare system, as well as licensing healthcare providers, including hospitals. The National Health Insurance Fund (NHIF) and its regional branches are primarily responsible for purchasing health services.

The population of Bulgaria receives a range of benefits through the healthcare system, including access to primary care, specialist care, hospitalization, emergency care, maternity care, dental care, and prescription medications. Preventive services and screenings are also provided. Primary care is provided by general practitioners (GPs), who are independent practitioners contracted by the NHIF. They operate in individual or group practices, and act as gatekeepers for specialist care, diagnostic tests, and hospital care. However, monthly quotas for patient referrals can lead to some patients bypassing primary care doctors and going directly to hospital emergency departments.

To access healthcare benefits, Bulgarian citizens must be registered with the NHIF. Despite the legal requirement for universal health coverage, a significant portion of the population remains uninsured, particularly among the long-term unemployed, the Roma community, and those living in disadvantaged regions.

Claims data, registries, and electronic health records are managed primarily by the National Center for Public Health and Analyses (NCPHA), which operates under the Ministry of Health. This organization is responsible for the collection, storage, and analysis of healthcare data, as well as maintaining the national electronic health record system. Individual healthcare providers also maintain their own electronic health records, which are integrated into the national system.