Bulgaria

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Healthcare System

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.

Administrative or Claims Data

Database: NSI Treatment and Health Facilities

Sponsor, manager or home institution: National Statistics Institute.

Primary purpose: To provide information on the country's health network, including types of medical and health facilities, bed types, territorial distribution, and ownership forms.

Type of information: Data dictionary is not publicly available.

Available type of information: Beds in treatment institutions for hospital care, types of bed, medical and health facilities, medical staff, physicians by specialties in medical and health facilities, population of one physician, population of one dentist, statistical zones, statistical regions and municipalities.

Source of Information: The reporting form provided by the medical and health care facilities covered by the study. The source of information on the number and beds in the Homes for medical and social care for children is the study "Homes for medical and social care for children" conducted by NSI.

Data level: Hospital level.

Available data level: Regional and national level.

Number of Records: All medical facilities for inpatient care, outpatient care facilities and other medical and health care facilities are covered.

Date Range: 2001 onwards.

Cancer Areas of Interest: Unknown.

Data access: Partially publicly available [1]. Instructions to request data for restricted content [2].

Contact information: Information [3].

Registries

Database: National Cancer Registry

Sponsor, manager or home institution: Bulgarian National Cancer Registry.

Primary purpose: Systematic collection, storage, organization, analysis, interpretation, publication and protection of data for persons with malignant neoplasms and carcinoma in situ throughout the country.

Type of information: Data dictionary was not found.

Available type of information: Cancer incidence, cancer deaths, number of new cases, distribution of newly diagnosed cases, primary cancer site, age, sex.

Source of Information: Information periodically sent by 13 regional cancer centers.

Data level: Patient level.

Available data level: Regional and national level.

Number of Records: Unknown.

Date Range: 1993 onwards.

Cancer Areas of Interest: Cancer Areas of Interest: Bulgarian National Cancer Registry

Data access: Partially publicly available [4]. Instructions to request data for restricted content [5].

Contact information: Information [6].

Database: NSI Cause of Death

Sponsor, manager or home institution: National Statistical Institute.

Primary purpose: To provide a standardized and comprehensive source of cause-related mortality statistics for international and national comparisons of population health status in European countries

Type of information: Data dictionary is not publicly available.

Available type of information: Mortality; Causes of death; Year; Sex; Age group; Statistical zones; Statistical regions and districts [1].

Source of Information: Medical death reports.

Data level: Patient level.

Available data level: Regional and national level.

Number of Records: Unknown.

Date Range: 1994 onwards.

Cancer Areas of Interest: Cancer Areas of Interest: NSI Cause of Death

Data access: Partially publicly available [7]. Instructions to request data for restricted content [8].

Contact information: Information [9].

Database: Bulgarian European Health Survey

Sponsor, manager or home institution: National Statistical Institute.

Primary purpose: To assess the health status, lifestyle (health determinants) and the use of health services by the EU population, using a harmonized toolkit, ensuring to a large extent comparability of data between EU countries.

Type of information: Data Dictionary: Bulgarian European Health Survey 2019. More metadata information [10].

Available type of information: Self-perceived health; People having a long-standing illness or health problem; Self-reported prevalence of chronic diseases; Admission as an inpatient in a hospital in the past 12 months; Admission as a day patient in a hospital in the past 12 months; Last time of visit to a dentist or orthodontist; Last time of consultation of a general practitioner; Last time of consultation of a medical or surgical specialist; Blood pressure measurement by a health professional; Blood cholesterol measurement; Consumption of fruits by frequency; Consumption of vegetables by frequency; Smoking behaviour; Frequency of alcohol consumption in the past 12 months; Blood sugar measurement; Boddy mass index of persons aged 18 and over; Sex; Age [2].

Source of Information: Survey responses.

Data level: Respondent level.

Available data level: National level.

Number of Records: Unknown.

Date Range: 2008, 2014 and 2019.

Cancer Areas of Interest: Unknown.

Data access: Partially publicly available [11]. Instructions to request data for restricted content [12].

Contact information: Information [13].

Latest Policymaking Initiatives

Report: EU Country Cancer Profile 2023

Sponsor, manager or home institution: OECD and European Commission.

Primary purpose: To provide reliable data on cancer prevention and care, identifying trends, disparities, and inequalities among EU Member States and regions to guide interventions under Europe's Beating Cancer Plan.

Type of information: National cancer burden; Cancer incidence and mortality; Risk factors for cancer; Early detection programs (screenings); Cancer care performance, The impact of COVID-19 on cancer care.

Data level: National level.

Access to information: Access Information [14].

Quality of Life Research

List of Articles: Quality of Life [15].