Bulgaria entered the EU on 1 January 2007, averaged more than 6% annual growth from 2004 to 2008, driven by significant amounts of bank lending, consumption, and foreign direct investment. Successive governments have demonstrated a commitment to economic reforms and responsible fiscal planning, but the global downturn sharply reduced domestic demand, exports, capital inflows, and industrial production. GDP grew approximately 2.2% in 2011. Corruption in the public administration, a weak judiciary, and the presence of organized crime remain significant challenges and continue to hamper the country’s investment climate and economic prospects.

Bulgarian healthcare is universal and state funded through the National Health Insurance Fund. Bulgaria spends around 4.2% of its GDP on healthcare and has around 1.8 doctors per 1,000 people, which is above the EU average.

The private healthcare sector however, sits in stark contrast to the overall picture. Many doctors and dentists turned private with the introduction of the free market following the fall of communism, leading to a glut of private practices. This meant that clinics had to invest in better technology and provide better staff training and service in order to gain a competitive edge in a crowded market. At the same time, a low wage economy forced them to keep their prices down.

The result is a very well equipped private sector for medical work, cosmetic surgery and cosmetic dental surgery, with incredibly low prices.

Healthcare system in Bulgaria consists of both public and private sectors. The Ministry of Health is responsible for the effective operation of Bulgaria’s National healthcare system. The regional health centres are accountable for the local administration of healthcare in each of the 28 administrative districts of the country. The National Health Insurance Fund manages the health insurance system in Bulgaria, which is carried out by its territorial divisions, namely the 28 regional Health Insurance Funds. It is compulsory that the working population in the country contribute to the national health insurance system. Under the State healthcare system, Bulgarians are entitled to free or subsidised medical care from a doctor. It also includes free doctor referrals to specialists, reduced price medicines and dental treatment.

It is the responsibility of the employers to enroll employees into the health insurance fund when they first join the company. Both employers and employees contribute to the insurance fund. Contribution from employees is deducted directly form their monthly salaries and put into the Bulgarian social security. Every year, the Bulgarian parliament will decide what the budget for the National Health fund is, and this would in turn determine what the amount of contribution to the insurance fund is. People, who are self-employed, are required to make their own contributions towards the healthcare fund. Dependents of the employed family members are covered by the public healthcare system; this is provided that the employed members make a higher rate of contribution to the health fund. The unemployed, pensioners, the poor, students, soldiers, civil servants and vulnerable groups of people have exemptions and are not required to contribute to the healthcare fund.

The medical staff in Bulgaria are very well trained, although the standard of their health facilities and cleanliness are not on par with the standards of other western European countries. Patients can choose to register with a doctor of their choice. If you want to visit a specialist or be admitted into a hospital, a doctor’s referral will be required. For patients who visit specialists or hospitals without a referral, they must pay for any services rendered.

Hospitals and clinics exist in all major towns and cities of Bulgaria, however, provision in rural areas is restricted. Most qualified medical staff are centered in the urban areas. Facilities in Bulgarian hospitals are adequate, but the health service was previously largely under-funded, which has resulted in many hospitals not being fully maintained. Moreover, specialised equipment and treatment may not always be available. In some cases, patients need to purchase the necessities such as drugs and food. The nurse to patient ratio in Bulgaria is low, as such, some of the general nursing duties like changing bed sheets and serving meals are expected to be done by the family members of the patient. Under-the-table payments do exist in the healthcare system in Bulgaria. This happens particularly more often with the expat population in the country.

Patients are admitted to a hospital with a doctor or specialist referral. If a patient goes to a hospital without a referral, they will only be admitted to the hospital after an assessment on the status of the patients was carried out to determine if hospital care is required. If the examination shows that hospital care is deemed unnecessary, the patient must pay for all the associated healthcare costs themselves.