Debate on the Healthcare User Fee in Bulgaria

Bulgaria faces a healthcare "bargain": Debate on patient fees shakes the system

Function and Philosophy of the Fee

Sofia, Bulgaria — The long-standing debate over the fate of the patient fee in healthcare has flared up again with new force, raising questions about social justice and the sustainability of the system. At the center of the discussion was Assoc. Prof. Lyubomir Kirov, chairman of NSOPLB, who in a television appearance emphasized the need for a complete change in the approach to the fee, which, in his words, has remained "young" in its value, while everything else has aged.

In an emotional commentary that captured the long-standing stagnation of the problem, Assoc. Prof. Kirov said: "I was a young and handsome man back then, and now I am some kind of old dude, but the fee remained young - it didn't grow up". He pointed out that since 2011, although the minimum wage has quadrupled, the patient fee has remained unchanged. This obvious disproportion is at the heart of the tension felt in the corridors of power and among health experts.

Assoc. Prof. Kirov clarified the two main functions of the patient fee, which, according to him, have lost their effectiveness over the years. The first is to limit overconsumption by preventing the formation of unnecessary queues in front of doctors' offices. The second function is co-financing, as the fee adds additional income to the health system. Despite these goals, the current situation shows that the fee does not adequately fulfill either of its two roles.

Welfare State or Social Inequality?

One of the most controversial aspects of the debate is the issue of groups exempted from the fee. Assoc. Prof. Kirov defined Bulgaria as a "very social state", but questioned the logic according to which children under 18, pensioners, and people with chronic diseases are exempted. According to him, "all of them use the services without any contribution". This comment raises questions about the distribution of the burden, which, in his words, falls only on working citizens.

"This fee is the only thing that working people have to give of themselves", Assoc. Prof. Kirov is adamant. He insists that exempting certain groups creates injustice and calls for a radical change in the system.

Proposal for a Fair Model

Assoc. Prof. Kirov presented a bold and direct solution to the problem. He stated that "there should be no one exempted from the fee. Everyone should pay it". According to him, if the state or another entity decides that a certain person should be exempt from this "burden", then they must bear the cost. As a possible mechanism for this, it was proposed that payment be made "against the receipt", so that the exempted person goes and is paid 2.90.

He was adamant that everyone should pay, and for those who cannot, the responsibility should be borne by the one who exempted them from the commitment. This approach, although controversial, offers a new perspective on healthcare funding and the redistribution of responsibilities.

The air in the television studio where the conversation took place was filled with tension as Assoc. Prof. Kirov expressed his arguments, which are likely to ignite a new round of debates among politicians and health experts. Whether his proposal will be accepted or will become another episode in the patient fee saga remains to be seen.