Bulgaria’s medical system is causing a serious headache for everyone in a country which – despite massive healthcare investment and the most hospitals per capita in the European Union – has the highest death rate across the bloc.
With 15 deaths per 1,000 people, Bulgaria has held the top spot in the EU’s mortality ranking for nearly a decade, according to the National Statistics Institute.
But it is hoped fresh, ambitious reforms to better distribute public funds and crack down on corruption will improve matters.
“This system needs a painful overhaul,” Health Minister Petar Moskov told AFP in an interview. “Health spending keeps rising while life expectancy falls and hospital stays and mortality rates are increasing.”
At 74 years, life expectancy is also among the bloc’s lowest. Even worse, Bulgarian children under the age of five are twice as likely to die as their European peers — a “nightmarish figure”, said Moskov.
The situation is particularly alarming among the country’s Roma minority, where an average of 20 out of every 1,000 toddlers died in 2014.
Moskov’s reforms aim to cut the death rate by 20% by 2020 and overhaul the way hospitals are financed.
A 53% rise in public spending over the past five years has brought no “tangible improvement in the quality of care”, said Vladislav Goranov, finance minister in the conservative government.
The services in place are a prime example of “extreme inefficiency,” he added.
They also put a huge burden on patients in what already is the EU’s poorest country. One in five Bulgarians lives below the poverty line, earning just 323 leva (€165) a month.
“Poor people from the villages sell their horses and carts to find money to pay for treatment of an illness,” said kidney specialist Ivan Georgiev from the northern town of Pleven.
The World Bank recently voiced alarm over the “disproportionately high” fees Bulgarian patients are charged for healthcare and medications – a share it said hit 43% in 2013, the highest in Europe.
“I have patients with hypertension who refuse to buy a more expensive and efficient drug and ask for something cheaper, running the risk of worsening their condition,” general practitioner Hristo Nikolov told AFP.
Currently, only 25% of the cost of hypertension drugs is reimbursed, said Nikolov, and even kidney dialysis – a lifesaver for some patients – is not entirely covered.
Meanwhile, many new hospitals have sprung, draining public funds and feeding what health minister Moskov called a trend of “over-hospitalisation”, with 40% more people hospitalised in Bulgaria than in other EU countries.
“I spent three days in hospital for a simple intestinal examination that took half an hour, but had I left earlier, the private hospital would not have been reimbursed,” said Rositsa Smilova, a saleswoman from Sofia.
Bribes for nurses
Rampant corruption also inflates the already exorbitant healthcare costs.
“We had to bribe the nurses so they wouldn’t neglect my father when he was admitted after a heart attack,” said electrician Kiril Stankov.
Moskov’s plan will reduce the number of hospitals receiving public funds and require digital fingerprints for all patients to avoid falsification of patient numbers.
Priority in funding will also go to patients suffering life-threatening conditions, who will be fully reimbursed, while those with lesser ailments can opt to wait or pay for their treatment.
“There will no longer be any difference between rich and poor when it comes to serious health problems. Heart attacks, strokes and cancer will be treated immediately and will be fully covered by the funds for as long as necessary,” the minister said.
The plan, to be implemented over the coming year, will also put new focus on prevention – nearly non-existent in current practice – including a possible tax on foods with high sugar and high salt content.