Introducing a second pillar of health insurance, operating under state supervision and modeled after the pension insurance system, is a potential solution for curbing the massive out-of-pocket payments made by patients. This was stated by Zdravko Shushkov, a candidate for Deputy Governor of the National Health Insurance Fund (NHIF), during his hearing before the Parliamentary Health Committee. His candidacy was officially proposed by the "Progressive Bulgaria" parliamentary group.

Shushkov clarified that the implementation of such an initiative does not fall within the authority of the NHIF but would require significant legislative changes. According to him, such a reform would expand the available financial resources, reduce the financial burden on patients, and create conditions for optimizing and restructuring the country's hospital network. During the hearing, he emphasized that the goal of reforms in the sector should be aimed at increasing public spending, as well as ensuring higher quality, more effective control, and the long-term sustainability of the system.

The candidate for Deputy Governor noted that he expects his role to be primarily associated with support functions, focused on the financial aspects and control mechanisms. He recalled that despite the annual increase in the NHIF budget, Bulgaria continues to hold a leading position among European countries in terms of the share of out-of-pocket payments for medical services. According to Shushkov, this seriously calls into question the efficiency of public spending. He highlighted several key reasons for this situation:

  • insufficient reimbursement for medicinal products;
  • shortage of preventive activities;
  • ineffective management of financial resources.

Shushkov added that a large portion of the budget is directed toward hospital care, while prevention and outpatient care remain underfunded, which inevitably leads to additional costs for treating complications that have already occurred.

In his presentation to the committee, he systematized the main challenges facing healthcare:

  • high levels of out-of-pocket payments for medical care, medications, and supplies;
  • frequent over-hospitalization;
  • insufficient prevention and a shortage of medical personnel;
  • regional imbalances and the existence of duplicating hospital structures;
  • suboptimal spending of funds and low patient satisfaction;
  • insufficient digitization of the system.

As concrete steps to address these problems, the candidate pointed to strengthening preliminary controls, implementing electronic preliminary controls, reforming national framework contracts, and organizing centralized tenders for medications. The latter, according to him, would lead to better predictability, budget savings, and a reduction in the final prices of medications.

Prior to Zdravko Shushkov's hearing, the members of the parliamentary committee conducted hearings for the candidates for the position of NHIF Governor – Dr. Vladimir Daskalov and Stanimir Mihaylov.