Bulgaria’s inefficient state healthcare system is failing to provide care for pregnant women who cannot pay health insurance, according to a report by the Bulgarian National Audit Office.
With one of the smallest preventive health budgets in the European Union, Bulgaria’s inefficient state fund is struggling to reach its most vulnerable citizens.
Nearly one million working-age citizens, a share of 25%, do not pay health insurance. These are people mainly from the country’s large Roma minority, workers in the informal sector and citizens who are permanently excluded from the labour market.
The National Audit Office specifically points out in its report that many pregnant Bulgarian women have not had a single check-up during pregnancy and have not taken advantage of the opportunities created by the state programme.
“The reasons for this can be found in the low education and health and social status, the lack of effective information campaigns and insufficient work with mediators to direct pregnant women to the state-provided medical care for mother and baby,” the report said.
Only 40 per cent of uninsured pregnant women have used the state-funded medical check-up programme, and in 2022, their share continued to fall to 37%.
Ethnic differences in life expectancy
From 1 January 2023, the state will pay for up to four preventive check-ups a year for uninsured pregnant women, as well as provide the right to hospitalisation for high-risk pregnancies up to twice a year.
However, the financial resources for high-tech examinations and consultations of pregnant women without health insurance for early detection of various congenital anomalies of the foetus are not fully used.
A study by researchers from the National Statistical Institute, published in August 2024, shows a serious difference in life expectancy between different ethnic groups in Bulgarian society.
Ethnic Bulgarians live six years longer than Roma, who comprise about 10% of the population. Bulgarian women live an average of 78.6 years, women from the Turkish ethnic group 76.9 years, and women from the Roma ethnic group survive an average of 71 years.
A Eurostat study in 2021 showed that Bulgaria is among the EU countries that spend the smallest proportion of their GDP on health prevention – just 0.28%.
Last in this ranking is Slovakia (0.12), where the Roma ethnicity is also estimated at 9-10% of the population.
“The state is not providing funds to conduct effective education and awareness campaigns to raise awareness among the population, especially in rural areas and among vulnerable groups, about health promotion and the opportunities created under the programme, their benefits in preserving health, maternal and child life, which should have a positive impact on reducing mortality indicators,” the audit said.
Maternal and infant mortality
Bulgaria’s maternal and child health indicators have not yet reached the EU average.
Infant mortality rates for the period 2010 to 2022 decreased by 4.6%, but Bulgaria still has the worst performance at 3.3 deaths per 1,000 babies in 2022.
The country ranks among the EU’s top countries for infant mortality, behind Romania and Slovakia, where Roma make up a large share of the population, and Malta.
National Health Insurance Fund data for 2023 show that Bulgarians skip preventive check-ups on a massive scale, even though they are compulsory for all insured citizens. The percentage of people over 18 who went for a preventive check-up last year accounted for 41%, while in 2021, it reached 36%.
In Bulgaria, health check-ups are compulsory by law, but there are no penalties for citizens who decide not to have annual check-ups.
[Edited by Vasiliki Angouridi, Brian Maguire]