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Country profiles of health system responses to the crisis | Bulgaria
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immunization, ambulatory mental health, dermatological and sexually
transmitted infection care, in vitro fertilization, immunosuppressive
drugs, drugs for rare diseases, hormone therapy), where they are only
available to the insured (2012).
• Created a positive list of medical devices (2012).
User charges
• Reduction of user charges for pensioners from 1% of the minimum
monthly salary to BGN 1 per outpatient visit, with SHI paying the
difference between the reduced and full user charge to outpatient
physicians (2008, protection abolished in 2011).
• User charges set as a percentage of the minimum monthly salary replaced
by fixed co-payments to protect pensioners and other vulnerable groups
(2012).
• The fixed co-payments rate increased for outpatient visits and inpatient
care following lobbying by the Physicians' Union, but it still remains less
then 1% of the minimum monthly salary (second half of 2012).
Changes to health service planning, purchasing and delivery
Prices of medical goods
• Moved procurement from the Ministry of Health to hospitals and allowed
SHI to contract selectively with manufacturers offering the lowest prices
(2011).
Salaries and motivation of health sector workers
• The Ministry of Health introduced a fee ceiling for all hospital contractors
of the National Health Insurance Fund. The maximum fee for a team of
physicians is BGN 900 and BGN 700 for one physician. Previously the
fees were set by every hospital without regulation (2010).
Payment to providers
• The Health Insurance Act was amended in 2009 to give the Ministry
of Finance the role of setting prices for health services funded by the
National Health Insurance Fund. The Ministry of Finance initiated this
policy. Until that time prices were negotiated between the Fund and
doctors' organizations. As a result of dissatisfaction expressed by the
Physician's Union, a new amendment was made to the Health Insurance
Act in 2011 and the pricing process is once again implemented by
negotiation between the National Health Insurance Fund and doctors'
organizations.