The health status of people in Bulgaria has improved more slowly than in other EU countries, as shown by persistently low life expectancy, a new report by the European Commission and Organisation for Economic Co-operation and Development says.
Several recent reforms have attempted to shift the Bulgarian health system away from over-reliance on hospital care and to increase efficiency.
“Nevertheless, challenges in terms of access and quality remain substantial,” according to the 2018 Health at a Glance: Europe report, released on November 22
Life expectancy at birth in Bulgaria was 74.7 years in 2015, which is the second lowest in the EU, and almost six years below the EU average.
Cardiovascular diseases and cancer cause more than four-fifths of all deaths. Furthermore, vast regional inequalities exist as exemplified by up to six-fold differences in infant mortality across regions. Bulgaria also has large differences in health status between socioeconomic groups.
Furthermore, with 3.1 years gained, improvements in life expectancy since 2000 have not been as rapid as in most other countries.
Life expectancy at birth for women in Bulgaria remains the lowest in the EU, although women recorded a steeper increase than men.
As of 2015, the gender gap is seven years.
Bulgaria has relatively high maternal mortality rates (although the 12 deaths per 100 000 births recorded in 2013 seems to be an exception compared to other years).
Infant mortality in Bulgaria is more than 80 per cent higher than the European average (6.6 deaths per 1000 births versus 3.6 in 2015).
What is more, the worst performing region (Yambol) recorded an infant mortality rate that is six times higher than the best performing region (the capital Sofia) in 2016 (National Statistical Institute, 2017).
“The difference in life expectancy by socioeconomic factors, such as level of education, is particularly large in Bulgaria,” the report said.
“Life expectancy at birth for university-educated Bulgarians is seven years higher than for those with no more than lower secondary education.”
In 2014, smoking rates were the highest in the EU with 28 per cent of adults in Bulgaria smoking tobacco every day.
Levels of binge drinking (as a measure for excessive alcohol consumption), are lower than in other EU countries but overall per capita alcohol consumption is the fifth highest.
Prevalence of obesity is low but rising quickly, in particular among male adolescents. Legislative efforts to mitigate risk factors have yet not been effective, the report said.
Despite decreases since 2000, in Bulgaria deaths from cardiovascular diseases remain the leading cause of death for both women and men and are far above the EU average.
Cancer is the second leading cause of death, accounting for 19 per cent of all deaths among men and 14 per cent of all deaths among women, which is below the EU average and slightly increasing.
Deaths from diseases of the digestive system caused five per cent of all deaths in men ( two per cent in women) and deaths from respiratory diseases four per cent in men and three per cent in women.
In 2015, Bulgaria spent 1117 euro per head on health care, less than half the EU average (2797 euro).
Roughly half of total health expenditure is publicly financed and Bulgaria has exceptionally high out-of-pocket payments – 48 per cent – the highest in the EU.
About 12 per cent of the population lack insurance coverage.
“The revenue base for the Social Health Insurance (SHI) remains narrow due to low incomes, many uninsured individuals and a large informal sector.”
Unmet needs for medical care point to access problems across all income quintiles for financial reasons. Travel distance and availability of doctors remain important barriers, especially for lower income groups, the report said.
Accordign to the report, some progress has been made in terms of governance and accountability.
“Given the wide range of challenges – a fast ageing society, revenue mobilisation, professional migration and workforce shortages, to name but a few – the direction of recent reforms is encouraging, but these reforms need more time to become effective,” the report said.
(Photo: Paul Barker/sxc.hu)