Healthcare in Bulgaria

The system

Healthcare in Bulgaria is paid both for citizens of the country and for foreigners. But the way you pay differs.

Foreign nationals – people who have come for a holiday, tourists or holders of a long-term residence permit – are required to have insurance. If you need to see a doctor, it is enough to call the insurance company and then follow the instructions you receive. Some insurers have contracts with hospitals and deal with medical facilities directly. Others reimburse the cost of treatment after the fact. Despite differing opinions, the way all insurance companies work is practically the same, and with the same institutions. The only difference is the price and the approach different brokers take to their clients.

Bulgarian citizens and holders of a permanent residence permit (EU long-term resident status) who join them use the services of the «Здравна каса». For this, «здравни осигуровки» must be paid every month. In 2018 this contribution amounts to 20,4 лв. The unemployed pay it themselves; for everyone else the employer pays.

Children are exempt from the obligation to pay osiguróvki until they finish school. University students also do not pay the contribution until the end of their studies.

If arrears on contributions build up, they must be paid off in order to use medical care. But it is better not to let it come to that and to pay regularly.

Personal doctor

Every holder of an ЕГН who pays contributions is entitled to use the services of a personal doctor («личен лекар»). This is a family therapist whom you can approach with any health problem. He issues certificates, makes prescriptions and, if necessary, provides referrals to specialists (except dentists, whom you can visit on your own if needed).

An appointment with such a doctor costs 2,9 лева. Pensioners pay one lev; privileged categories (which include pregnant women, children and many others) are seen free of charge.

You can choose a personal doctor on the recommendation of acquaintances or on the basis of reviews. The registration procedure takes a few minutes. Changing doctors, however, is harder – it is only possible in June or December.

A family doctor is not obliged to make house calls; you have to come to the appointment yourself. For this reason it makes sense to find a doctor closer to home. Some doctors, however, do make house calls for an additional fee.

Dentistry

No referral is needed to book an appointment with a dentist – it is enough simply to come to the doctor you like and agree on a time. The «Здравна каса» covers dental services only in part – a detailed price list is available in every specialist’s reception. If the doctor or clinic does not work with the «Здравна каса», you will have to pay for the treatment yourself from start to finish.

Good dentists are usually booked up weeks in advance. Only a few doctors are prepared to see patients «off the street» without a prior appointment.

Foreigners in Bulgaria are often unpleasantly surprised by the rather casual attitude to hygiene typical of Bulgarian dentists and other doctors. Dust flying in through the windows, no shoe covers, dirty floors – all quite common. Nevertheless, this does not affect the quality of the medical care.

The blue booklet

To visit specialists, including dentists, you need the so-called «Синя книжка». This is a document listing the patient’s details and those of his personal doctor. After treatment, the specialist records his own details there, states which services he provided and how much they cost.

Bear in mind that not all doctors work with the «Здравна каса». When seeing a doctor in private practice, the blue booklet is not needed, and the whole payment comes out of your own pocket. But even if a medic works with the system, some services may be chargeable.

Hospitalisation

Hospital treatment on a doctor’s referral is free for those who pay contributions – provided, of course, that it is a state medical facility and not a private one. You only have to pay a symbolic sum for the inpatient stay. In most Bulgarian hospitals patients are not fed, but there is usually a café on the premises from which food can be ordered. No one guarantees that it is healthy or matches the recommended diet. The other option is to eat what relatives bring.

Foreigners with a long-term residence permit pay for treatment everywhere. If the insurance company has no contracts with particular hospitals then, according to those with experience, it is better to use private rather than state clinics. The level of comfort is higher there, and the prices are the same and sometimes lower than in state hospitals.

The best Bulgarian clinics and hospitals

Opinions about Bulgarian medicine are quite contradictory: you cannot always go to the first specialist you come across, and you usually have to look for a doctor by recommendation. The quality of medical services is often good, but the service is beneath all criticism, and sometimes the quality of treatment is also far from ideal.

According to Bulgarian rankings, the best hospitals are in Sofia. They are:

• ВМА (multi-profile hospital, Military Medical Academy);
• МБАЛ «Токуда болница София»;
• «Софиямед» University Hospital;
• УМБАЛ «Св.Екатерина»;
• CityClinic;
• МЦ «Полимед».

Medical facilities such as Life Hospital in Burgas, «Света Марина» and «Света Анна» in Varna, and «Света Каридад» in Plovdiv are also well spoken of.

Medical insurance for foreigners

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