The difficult transition to national health insurance in Bulgaria

Abstract

Health sector reform in Bulgaria aims to enhance sector efficiency, increase resources allocated to the health sector and target public resources to the most cost-effective interventions. The health system is however currently being changed in two directions-social and commercial. Transition processes in health include the simultaneous creation of market-based behaviour of all participants in the health market, and the establishment of a national social insurance system that should prevent some aspects of the market from emerging. By definition and in practice, those two processes are working quite separately and they are not necessarily compatible, although features of one process can traced within the other. The Bulgarian model of health care retains an emphasis on a dominant public sector. This model requires significant as well as sustainable financing from the government side. However in practice the model is being undermined by financial difficulties in financing the national social health insurance that arise in good part from the commercialised elements of the system. These in turn generate very substantial inequalities in access to care, through inability of part of the population to pay official and unofficial charges. Copyright © 2006 John Wiley & Sons, Ltd.