The life expectancy of Bulgarians has improved but is still the lowest in the EU.
This is according to the annual State of Health in the EU report, compiled by the OECD and the European Observatory on Health Systems and Policies, in co-operation with the European Commission, released on November 28 2019.
Underdeveloped preventive actions and outpatient (or ambulatory) care contribute to poor health outcomes, the report said.
“The social health insurance system is compulsory yet in practice there are significant gaps in population coverage and what is offered in the benefit package.
“Recent reform initiatives have focused on controlling spending and enhancing efficiency, including the introduction of health technology assessment (HTA) for pharmaceutical reimbursement, and trying to shift the health system’s focus away from hospital-centred care.”
Life expectancy in Bulgaria increased by more than three years between 2000 and 2017 but larger increases in other EU member states have widened the gap between Bulgaria and the EU average.
Circulatory system diseases and cancer are the principal causes of death, and there are significant disparities in health status across gender, regional and educational lines. Morbidity from infectious diseases such as tuberculosis (TB) are also an ongoing concern, the report said.
Reducing the high prevalence of behavioural risk factors poses a major challenge.
“Despite a slight reduction in tobacco consumption, the rate of smoking among adults is the highest in the EU and stood at 28 per cent in 2014 (36.4 per cent among men).
Smoking among teenagers is also common, the report said.
Heavy alcohol consumption in 2014 was slightly below the EU average for adults, but is increasing among teenage boys.
“While the obesity rate among adults is just below the EU average, it is a growing problem among children, with one in five being overweight or obese.”
Despite doubling since 2005, per capita health spending, at 1311 euro,was the fourth lowest in the EU in 2017. This represents 8.1 per cent of GDP, below the EU average of 9.8 per cent, but higher than in neighbouring countries.
Out-of-pocket (OOP) spending in 2017 was the highest in the EU (46.6 per cent compared with 15.8 per cent on average), and is mainly driven by co-payments on pharmaceuticals and outpatient care.
“The prevalence of informal payments also adds to household costs for health care.”
Both preventable and treatable causes of mortality are among the highest in the EU, indicating a large scope for improving disease prevention and the effectiveness of care.
“A lack of data on key indicators hampers the monitoring of care quality.”
Although self-reported unmet needs are at the lowest level since 2008, low-income groups are more heavily affected. High levels of OOP spending, and lack of health insurance for a significant proportion of the population, are the main barriers to accessibility.
“The financial sustainability of the health system is challenged by a heavy reliance on private expenditure as well as the shrinking working-age population that contributes to the revenue base of social health insurance.”
Efforts to improve efficiency by reorienting service delivery and resources away from hospitals “have proven difficult,” the report said.