New rules in Bulgaria's national health contract for 2026–2028 will slow the diagnosis and treatment of stroke, neurologists warned at the BTA National Press Club.
The doctors say two clinical pathways set clashing time requirements. They say the new pathway for transient ischaemic attack (TIA) needs to be rewritten.
Three specialists spoke to journalists: Dr Filip Alexiev, chair of the Bulgarian Stroke Society, Assoc. Prof. Rosen Kalpachki, the society's founder, and Georgi Georgiev, deputy chair of the Stroke and Aphasia Association. Doctors from Sofiamed hospital were with them. They said they were not invited to the talks on the clinical pathways and the contract, and took no part in them. The contract was signed in early September and published in the State Gazette on 25 September 2026.
Dr Alexiev said time is decisive in a stroke and every minute counts. The new TIA pathway requires doctors to wait one hour before they assess the symptoms and decide on treatment. He believes this goes against modern medical standards. He told BTA: "We can't wait an hour and only then decide whether and how to treat a stroke."
Thrombolysis must start within 4 hours, and thrombectomy is done within 6 hours, depending on the patient's condition. Dr Alexiev also said the rules on imaging are unclear, and some of the tests are over-diagnosis, meaning they are not needed.
Assoc. Prof. Kalpachki said the changes are more likely to make things worse for stroke patients. In his view, the extra requirements have no sound medical basis and delay treatment.
"We want to set up a network of stroke treatment centres, and at the same time administrative rules get in the way of treatment," Assoc. Prof. Kalpachki told BTA.
He said the aim is for people across the country to have equal access to stroke treatment. In his view, the clinical pathway system cannot provide complete treatment and care. He said nothing changes in the care of patients after they leave hospital, and there is still no national plan to fight stroke.
Georgi Georgiev called for a multidisciplinary approach. In his view, the whole system must be ready to take in a patient, no matter where they live.
On 25 September we reported that the medical centre in Tsarevo had temporarily stopped check-ups on referrals from the National Health Insurance Fund (NHIF) because of the new national framework contract. The centre said the stop would last at least two weeks and applies across the country.
The Bulgarian Stroke Society will hold its fourth national congress in Sofia from 23 to 25 October 2026. Specialists in prevention, early diagnosis, modern treatment, rehabilitation and long-term care after stroke will share knowledge, new research findings and good clinical practice.