Bulgarian Healthcare: You Pay Dearly to Die Early
After the beginning of the coronavirus pandemic, the average life expectancy in Bulgaria has decreased by 1.5 years compared to 2019 and now Bulgarian citizens live (73.6 years) with seven full years less than the average European (80.6 years).
The collapse is the highest in Europe (twice the average) and, in addition to the record mortality from COVID-19, is explained by the poor efficiency of Bulgarian health care, which leads to more than the EU average deaths from curable and preventable diseases.
This is the conclusion of the European Commission's report on the state of health in the EU, published in late 2021.
According to the report, despite the significant increase in health care costs in Bulgaria, they remain the lowest in Europe, and the lack of prevention dooms Bulgarians to suffering from diseases that could be avoided or cured and lead a better life.
“Despite improvements in the health system over the last decade, the impact of persistently high-risk factors, high additional payments by patients and excessive focus on hospital care continue to hamper the system,” the European Commission said in a statement.
It says the COVID-19 pandemic has heightened the need for additional investment in the health sector, including better preparedness for future health crises. “For Bulgaria, this challenge includes investments to create a unified health information system to accelerate the introduction of e-health and improve working conditions in the sector.”
The healthcare system
The main criticism of the healthcare system in Bulgaria is its low efficiency. There has been no visible reduction in deaths from treatable diseases in the last decade, with levels well above the EU average, the report said.
Bulgarians who die from treatable diseases are twice as many as other Europeans, especially when it comes to heart attacks and strokes. 42% of the deadfall victim to both diseases, followed by 10% of colon cancer. All three diseases are considered avoidable and treatable.
The survival of cancer patients in Bulgaria is lower than the European average for all common cancers, the difference being particularly striking for lung cancer, where in Bulgaria 8% of patients survive, while in the EU they average 15%.
“These relatively low survival rates may be due in part to shortcomings in screening programs and a shortage of health system resources aimed at early detection and diagnosis,” the report said, adding that Bulgaria has not yet developed a national plan for cancer control.
It is pointed out that the mortality rate from COVID-19 is 65% higher than the EU average and while in the first wave in 2020 the pandemic-related deaths in Bulgaria were 6% of all deaths, in the second - at the end of the same year, they reached 89% (the report does not contain information for 2021).
The European Commission identifies unhealthy diets as a major health risk, followed by smoking, polluted air and alcohol.
“Nearly half of all deaths may be related to behavioral factors,” the report said. It says that Bulgaria has the highest number of smokers in the EU, that less than 60% exercise, and only one in three eats healthily. While a decade ago Greece led in the number of smokers, now its place is taken by Bulgaria, where one in three adults smokes every day, as well as a third of teenagers. Bulgarian girls are also record-holders in Europe, with 38% of girls under 15 smoking. Thus, it becomes clear why after heart attacks and strokes lung cancer is the third most common cause of premature death in Bulgaria. 11.4 liters of alcohol per capita are consumed annually, but obesity levels are lower than the European average.
The European Commission considers that the lack of results related to smoking cessation is due to the non-implementation of existing legislation and the lack of awareness-raising campaigns on the harms of smoking.
How money is spent on health
The European Commission claims that Bulgarians pay the most for health care in the EU. While 60.6% of expenditures come from the state budget, 37.8% are surcharges for services not included in health packages and for medicines. This is more than 2.5 times the average that EU citizens have to pay for health above their tax deductions. More than 1 million people are uninsured, which limits their access to health care.
The high share of co-payments has a disproportionately large effect on low-income households, the report said.
Health spending has almost doubled in the last decade (+ 83%) but remains the lowest in the EU. The cost per capita is 1273 euros, while in the EU it is on average €3500.
The organization of the health system is also assessed as unbalanced, with the European Commission emphasizing that it is too focused on hospital care and the sale of medicines at the expense of outpatient care and disease prevention. 40% of health expenditures in Bulgaria go to hospitals, 36% to medicines, 18% to outpatient care and 3% to prevention.
According to European experts in Bulgaria, hospitals treat various conditions that can be successfully treated in outpatient care (including asthma and diabetes). On the other hand, the system of issuing referrals for consultations with specialists makes every third person go directly to hospitals (health insured) or pay out of pocket for a visit to a specialist and treatment (if he can afford it).
Thus, the number of patients discharged from hospitals in Bulgaria is twice as high as in the EU, and according to the European Commission this is due to “underdeveloped and underfunded preventive health services and primary care.”
Is there anyone to treat patients?
According to the European report, there are more doctors in Bulgaria than the EU average, but they are not evenly distributed both territorially and by specialty.
In Bulgaria 4.2 doctors per 1000 inhabitants (3.9 in the EU) and 4.4 nurses. However, the distribution of doctors in the country is uneven. Pleven has the most doctors in relation to the population - 63 per 1,000 people, followed by Sofia and Plovdiv - 51 each, and Varna - 50.7. But in Kardzhali there are only 24 doctors per 1,000 potential patients, and in Dobrich and Silistra, 27 and under 28, respectively. It is said that attracting young doctors to remote areas to replace retirees is particularly difficult.
Among the secondary medical staff, Bulgaria, together with Greece and Latvia, has the largest shortage of nurses, the main reasons for this being emigration, aging, poor working conditions and low pay. The report does not fail to note the protests of the sisters before and at the beginning of the pandemic, when they demanded decent pay.
At the same time, the number of people who cannot afford health care due to poverty, lack of health professionals and the need to wait has decreased tenfold in 10 years and has even fallen below the European average. However, the need for additional payment makes many, especially the uninsured, turn to the emergency services, because there the service is free.
The COVID pandemic
According to the European report, at the beginning of the pandemic, the authorities were able to react quickly to increase and redistribute funding for hospital care, tests and teleconsultations. But they have been too slow to implement measures to limit the spread of the second wave. Test levels remain too low despite increased laboratory capacity.
The European Commission believes that not enough attention is paid to the treatment of patients with COVID-19 at home, and the slow pace of vaccination further exacerbates the impact of the pandemic on human health and society.
The electronic directions for PCR testing and electronic prescriptions are cited as “an important step towards e-health”, but the COVID-19 application is recognized as a failure with only 50 thousand downloads and practically does not work. The report says that in 2021 a system should have been launched to record and store electronic health records and medical data for each patient, including examinations, treatment, prescription forms, laboratory tests, referrals and digital certificates for vaccination against COVID. -19.
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