catastrophic health
catastrophic health

Bulgaria’s high out-of-pocket payments for health care undermines progress towards universal health coverage

Bulgaria has a high incidence of catastrophic health spending compared to other European countries. A new report by WHO/Europe launched today at the Bulgarian parliament reveals that in 2018, 1 in 5 households incurred out-of-pocket payments that exceeded their capacity to pay for health care by at least 40%. Catastrophic health spending may mean a household can no longer afford to meet other basic needs, such as food, housing and electricity.

People paying out of pocket for outpatient medicines is the main driver of catastrophic health spending in Bulgaria. This kind of spending affects poorer households, older people and people living in rural areas the most, and it has increased over time, notes the new report ‘Can people afford to pay for health care? New evidence on financial protection in Bulgaria’.

Although the country has made progress in some areas, out-of-pocket payments accounted for 39% of spending on health in 2019, far above the European Union (EU) average of 21%, says the report.

“Bulgaria’s heavy reliance on out-of-pocket payments for health care is a challenge to universal health coverage – the idea that everyone should be able to use quality health services without experiencing financial hardship,” said Tamás Evetovits, Head of the WHO Barcelona Office for Health Systems Financing. “The report recommends focusing on ways to ensure the National Health Insurance Fund covers the whole population and that it makes exemptions for people who cannot afford to pay co-payments for medicines and other health services.”

“Bulgaria has taken concrete steps to improve access to health care and reduce financial hardship for people using health services, but important gaps in health coverage remain, particularly for households with low incomes,” said Antoniya Dimova, Dean of the Faculty of Public Health at Medical University-Varna and the report’s lead author.

“This new analysis

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