The Bulgarian parliament has paused a €50 billion healthcare investment strategy until 2030, despite struggling with excessively high mortality and recording the largest negative population growth in the European Union.
Deputies from the ruling majority have slowed the adoption of the document following criticism from non-governmental organisations representing various branches of the healthcare system, which were demanding more funding.
The previous Bulgarian health strategy expired in 2020, since then the country has been spending on the health system without having clear strategic priorities.
The criticisms
The most serious criticism comes from private hospitals, which have a strong lobby in the parliament. They are asking for a larger share of direct investments from the state.
“There is not even a word about private medical facilities in the strategy, and they are 40% of the hospital structures in the country,” Svilena Dimitrova from the Bulgarian Hospital Association said during a debate on the strategy, which took place on 8 February.
According to the Association of Cardiologists in Bulgaria, the strategy does not reflect the need to improve the treatment of heart disease, the most common cause of premature death in the country.
“This is a serious problem for Bulgaria,” Vasil Traikov from the Society of Cardiologists commented during the debate. The organisation proposes a strategy that will promote early access to therapy and innovative medicine.
In addition, Dr Nikolay Sharkov from the Bulgarian Dental Union commented that the health strategy contains only a very small part of the necessary money for oral health.
Link to pharma package
The Bulgarian Health Strategy is also related to the country’s position under the new EU pharmaceutical legislation. One of the main goals of the political document is to reduce the cost of health services for Bulgarians, but some lawmakers believe the pharma package could lead to higher costs.
According to Bulgarian legislation, healthcare is supposed to be free for all citizens who pay a healthcare insurance levy, however, the reality is often different. National statistics show that nearly half of the €9 billion annual healthcare expenditure (out of a €100 billion GDP) comes from private payments, with the largest share being drug costs.
As Euractiv has reported, the EU’s poorest country is worried that new rules for the pharmaceutical sector will affect its ability to negotiate directly with drugmakers regarding pricing and reimbursement decisions, with the biggest risk for Bulgaria being an increase in medicine prices.
Even though the Bulgarian government does not yet have a final position on the new EU legislation, the position of the Bulgarian Ministry of Finance on the pharma package mentioned the need for measures that guarantee the provision of lower prices for medicinal products for countries with lower GDP, “not equalisation of prices for all countries.”
Sofia suggests that the European Commission’s proposed changes in the field of intellectual property law pose a risk of limiting incentives for innovative producers and creating upheavals in the decision-making process at the national level.
Urgent, effective strategy needed
Deputy Minister of Health Ilko Getov, who is also in charge of the pharmaceutical package, called on the disputing parties to move forward quickly, reminding stakeholders that Bulgaria has not had an effective strategy to determine policies in the sector for three years.
Moreover, Bulgaria was hit hard by the COVID pandemic, recording the second-highest death rate from the virus in the world after Peru. Nearly 40,000 Bulgarians died of Covid-19 – nearly 0.6% of the country’s population.
“The National Health Strategy is the only political document that is an indicator of the implementation of the Recovery and Resilience Plan, which must be approved by the National Assembly,” the Deputy Minister said. The remaining strategic documents were approved by the Council of Ministers.
PP-DB deputy Alexander Simidchiev, who is part of the ruling majority, also called on all interested parties to quickly find a way forward and urgently adopt the strategic document.
During a vote in January 2023, MPs asked the Ministry of Health to completely rewrite the document. Now, a working group in the National Assembly is expected to move forward with the required strategy edits.
[By Krassen Nikolov, Edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy Lab]
