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Title page 1

Contents 6

Foreword 4

Acknowledgements 5

Acronyms and abbreviations 9

Executive summary 10

1. Assessment and recommendations 12

Bulgaria needs to intensify efforts to reorient the healthcare system towards primary and preventive care in order to improve outcomes and... 13

Bulgaria has made progress to digitalise the healthcare system, but needs to further develop its data foundation for data-driven policymaking 16

Further efforts are needed to improve efficiency and sustainability to expand access and strengthen financial protection 17

References 21

Notes 21

2. Overview of Bulgaria's health system 22

Health status and healthcare needs 23

The healthcare system and its governance 32

Health data infrastructure and its governance 39

References 41

3. Access and quality of Bulgaria's healthcare system 43

Accessibility of healthcare 44

Quality in healthcare 48

Mental health care 56

Integrated care 57

Long-term care 58

References 62

4. The resilience and sustainability of Bulgaria's healthcare system 64

Health system financing and sustainability 65

Health workforce 71

Prevention and preparedness 74

References 80

Tables 8

Table 3.1. Bulgaria has lower nosocomial infection prevalence compared to EU countries despite the limited infection, prevention and... 55

Figures 7

Figure 1.1. Core set of indicators on health and health system, 2024 (or latest year available) 14

Figure 2.1. Life expectancy at birth has risen steadily over the last two decades, but remains below the OECD average and... 23

Figure 2.2. While maternal mortality is below the OECD average, infant mortality is higher than most OECD countries 25

Figure 2.3. Mortality due to heart attack and other ischaemic heart diseases is higher than in most OECD countries and mortality from... 26

Figure 2.4. The mortality rates in some regions were nearly double that of Sofia City 27

Figure 2.5. Bulgaria has higher preventable and avoidable mortality rates than most OECD countries 28

Figure 2.6. Daily smoking rates are higher than OECD countries, with notable difference between men and women 30

Figure 2.7. Alcohol consumption in Bulgaria is higher than the OECD average 31

Figure 2.8. Almost half of employees in Bulgaria reported exposure to risk factors that can adversely affect their mental well-being 32

Figure 2.9. 94% of the Bulgarian population is covered by social health insurance, which is below the OECD average and EU5 34

Figure 2.10. Laparoscopic procedures performed in Bulgaria are lower than in OECD countries 36

Figure 2.11. Bulgaria has one of the highest numbers of hospital beds 36

Figure 2.12. Hospital discharge rates in Bulgaria are higher than OECD countries 37

Figure 3.1. Bulgaria reports lower levels of unmet needs for medical care than OECD countries 44

Figure 3.2. The distribution of general practitioners varies, with a more than two-fold difference between the lowest (Kardzhali)... 47

Figure 3.3. The gap between men and women is large, even though cancer mortality rates are below the OECD average 49

Figure 3.4. Cancer survival rates are below the OECD averages 49

Figure 3.5. Nearly three out of five women had a cervical cancer screening in 2019, approaching the OECD average 51

Figure 3.6. While the number of PET scanner units is lower than the OECD average, Bulgaria has a higher number of radiotherapy units 52

Figure 3.7. Psychiatric bed capacity is comparable to the averages observed across the OECD and neighbouring EU5 countries 57

Figure 3.8. Total long-term care expenditure in Bulgaria was among the lowest across the OECD, with households being responsible... 59

Figure 3.9. Long-term care beds in institutions and hospitals, 2023 (or nearest year) 60

Figure 3.10. Activities of daily living and instrumental activities of daily living limitations in adults aged 65 and over, 2021-2022 (or nearest year) 61

Figure 4.1. Health spending in Bulgaria is lower than the OECD average both as a share of GDP and per capita 65

Figure 4.2. Public spending in Bulgaria is comparably lower than the OECD average, with almost half of total health spending being financed... 66

Figure 4.3. The level of public financing is high for inpatient and dental care, but lower for outpatient care, pharmaceuticals,... 67

Figure 4.4. While spending in hospitals is comparable to the OECD countries, spending in ambulatory care is lower 68

Figure 4.5. Inpatient services account for 94% of hospital-related spending in Bulgaria, higher than any OECD country 69

Figure 4.6. Spending on primary healthcare services is comparable to the OECD average 69

Figure 4.7. The number of practising doctors exceeds the OECD average; however, the number of nurses is lower than most OECD countries 72

Figure 4.8. The number of medical graduates has increased significantly between 2013 and 2023, becoming higher than any OECD country 72

Figure 4.9. Slightly over one in ten physicians are general practitioners in Bulgaria, lower than most OECD countries 73

Figure 4.10. The prevalence of hepatitis C in Bulgaria is higher than the OECD and EU5 averages 75

Figure 4.11. Vaccination rates for measles and DTP are higher than the OECD average, though measles coverage does not meet the WHO target 77

Figure 4.12. Vaccination coverage for influenza among the population aged 65 or over is increasing but remains below the OECD and EU5 averages 78

Figure 4.13. The volume of prescribed antibiotics has increased over the last decade and is higher than most OECD countries 79

Boxes 19

Box 1.1. Main assessment 19

출판사 책소개

알라딘제공
In recent decades, Bulgaria has seen significant improvements in life expectancy as well as in infant and maternal mortality. Despite these achievements, health status, risk factors for health, and the quality of care are worse compared to OECD countries. To address these weaknesses, Bulgaria has recently developed a strategic vision towards a more effective, integrated, and resilient health system, culminating in the adoption of the National Health Strategy 2030. Recent reforms have showed promising results in addressing shortages of healthcare professionals, improving the digitalisation of healthcare and fostering integrated care. However, Bulgaria still needs to address substantial challenges in order to improve population health, enhance the quality and safety of care, and build a more efficient and resilient healthcare system. This review assesses Bulgaria's efforts towards addressing these challenges and provides key policy recommendations for building a more equitable, efficient, and sustainable health system, identifying main areas for further alignment with OECD standards and best practices in the field of health.

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