Web-economic-crisis-health-systems-and-health-web

Bulgaria
Antoniya Dimova and Mina Popova
Economic trends
• Bulgaria's real per capita GDP growth decreased by 2.1% in 2009, but by
2011 recovered to levels above the European average; the unemployment
rate, however, continued to increase through 2011. Government
spending as a share of GDP fell in 2010 and again in 2011. Throughout
the crisis, health spending as a share of government spending has been
relatively stable, although below the European average. OOP expenditure
per capita has slowed since 2008, although it has maintained positive
growth (Bulgaria: Figs 1 and 2).
Policy responses
Changes to public funding for the health system
• The Ministry of Health's budget was reduced in 2009, 2010 and 2012.
• SHI revenues were lower than expected in 2009 but higher than expected
in 2010 and 2011 because of an increase in the contribution rate paid by
employers and employees (2009).
• In 2011, the Ministry of Health received transfers from SHI; SHI was
in surplus in 2009, 2010 and 2011 and the Health Insurance Law was
amended to lower its reserve from 10% to 9% of revenue (2011).
• The SHI contribution rate for employers and employees was increased
from 6% to 8% of contribution income (2009).
• The ceiling on contribution income was increased from BGN 2000 to
BGN 2200 (2013).
Changes to health coverage
Population (entitlement)
• No response reported.
The benefits package
• Provision for children under 18 years of age for direct access to specialists
without a cap on the number of referrals (2011).
• Benefits previously covered by the Ministry of Health (and therefore
available to the whole population) were moved to SHI (e.g. intensive care,