Five influential patient organizations have initiated a request for an urgent meeting with Prime Minister Rumen Radev and Minister of Health Katya Ivkova. The reason for their demand is the planned reforms in the healthcare system, regarding which the organizations have issued an official statement. Their main argument is that no change should be viewed as a series of isolated administrative steps, but rather as a comprehensive process that encompasses the patient's entire journey – from initial prevention and the diagnostic process, through treatment and medical evaluation, to the stages of rehabilitation and follow-up care.
The joint position has been signed by the Association of Patients Active in Healthcare; the Association of Patients with Kidney Disease and Friends; the National Alliance of People with Rare Diseases – Bulgaria; the Association for the Development of Bulgarian Healthcare; and the "Edna ot 8" Foundation. They are demanding that the meeting take place as soon as possible and have set out four key topics for debate:
- The future of the National Council on Prices and Reimbursement of Medicinal Products (NCPRM);
- The persistent problems with drug shortages and the need for more sustainable mechanisms for monitoring stocks and early response to risks;
- The planned reforms in regional health inspectorates, the emergency medical care sector, and the work of Territorial Expert Medical Commissions (TELK);
- The need for a separate, specialized discussion regarding the healthcare budget.
The patient organizations express concerns that any potential closure, restructuring, or change in the status of the NCPRM poses a serious risk of losing the expert capacity accumulated in the fields of health technology assessment, pricing, and reimbursement. They insist that any step towards change must be preceded by an in-depth impact assessment and include clear guarantees that patient access to new therapies will not be hindered, nor will procedures be delayed. The organizations are calling for the establishment of a more coordinated mechanism to address drug shortages.
Patient representatives are raising a broader question: whether the planned reforms will actually make the system more accessible to people. According to them, viewing regional health inspectorates, emergency care, and medical expertise as isolated objects is incorrect, as for every patient, these are interconnected stages. In their joint position, they emphasize that they are not defending specific structures, but are fighting to ensure a continuous and consistent patient journey through the system. They insist on being involved in the planning process from the very beginning, rather than after decisions have already been made.
The organizations insist that with every reform, it should be clear in advance what the final effect on patients will be and how it will be measured. Among their priorities is to understand whether diagnostic time will be shortened, whether the administrative burden of TELK will be reduced, and whether institutions will work more cohesively. This is critical for people with severe illnesses: for cancer diagnoses, timely therapy changes the prognosis, while for chronic kidney diseases, early monitoring can delay the need for dialysis. For rare diseases, where patients often lose years searching for a diagnosis and expertise, it is especially important that the system be organized around the person, not around the institutions.
Patient representatives also want a special focus on budget sustainability and the fair distribution of funds between prevention, diagnostics, innovation, and drug policy. Against this backdrop, last week Minister of Health Katya Ivkova commented on administrative changes within the ministry during a briefing. In connection with the resignation of Assoc. Prof. Angel Kunchev as Chief State Health Inspector, she stated: "There is no purge in the Ministry of Health. It is important to us that every civil servant works for the state." Ivkova added that Assoc. Prof. Kunchev's departure should not be linked to the ongoing administrative reform.