Abstract
The growth of public expenditure worldwide has set the priority on assessment of trends and establishment of factors which generate the most significant public costs. The goal of the current study is to review the tendencies in public healthcare expenditures in Bulgaria and to analyze the influence of the demographic, economic, and healthcare system capacity indicators on expenditures dynamics. A retrospective, top-down, financial analysis of the healthcare system expenditures was performed. Datasets of the National Statistical Institute (NSI), National Health Insurance Fund (NHIF), and National Center of Public Health and Analysis (NCPHA) were retrospectively reviewed from2014–2019 to collect the information in absolute units of healthcare expenditures, healthcare system performance, demographics, and economic indicators. The research showed that increasing GDP led to higher healthcare costs, and it was the main factor affecting the cost growth in Bulgaria. The number of hospitalized patients and citizens in retirement age remained constant, confirming that their impact on healthcare costs was negligible. In conclusion, the population aging, average life expectancy, patient morbidity, and hospitalization rate altogether impacted healthcare costs mainly due to the multimorbidity of older people and the rising need for outpatient hospital services and medications.
Highlights
Data were collected from the datasets of the National Statistical Institute (NSI), National Health Insurance Fund (NHIF), and National Center of Public Health and Analysis (NCPHA)
The study concept is based on the examination of the three main groups of factors affecting public healthcare expenditure, namely, demographic characteristics, economic factors, and healthcare system performance
We found a small increase in life expectancy in Bulgaria, which contributed to the increasing number of hospitalizations and total costs covering outpatient and hospital treatment
Summary
EU countries spent on average 9.6% of their gross domestic product (GDP) on healthcare in 2017 and 9.92% in 2019 [1,2]. The largest growth in healthcare costs per inhabitant between 2012 and 2018 were observed in Romania and the Baltic Member States [2]. The USA spent 19.7% of its GDP on healthcare in 2019 [3] with a projected respective growth of 5.4%and 2.4% for medical goods and services annually for the period 2019–2028. The largest share of healthcare costs is spent on noncommunicable diseases. In 27 EU countries and the UK, the direct costs of noncommunicable diseases (NCDs) are expected to increase by 0.8% annually from2014–2050, with population aging remaining the substantial driver of total healthcare expenditures [4]
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