Health Culture: Study Reveals Challenges in Healthcare

Bulgarians need to improve their health literacy and implement adequate policies. This is the conclusion of a comprehensive study conducted by Ipsos, which sheds light on key aspects of the healthcare sector in the country. The data from the study were presented at the XII Annual Conference "Innovations and Good Practices in the Healthcare Sector", organized by "Capital".

The conference brought together experts from the healthcare sector, representatives of state institutions, and other interested parties to discuss current challenges and the future of healthcare.

The study, commissioned by "Capital" and conducted in August 2025, covered 800 people from the urban population, aged 15 to 69 years. One-third of the participants were from Sofia, which gives significant representativeness to the data for the capital. The survey was conducted online, which allowed for the rapid collection of information from a large number of respondents.

One of the main focuses of the study was related to the continuity of health insurance. The results show that 76% of respondents have continuous insurance, which is a positive sign. However, nearly one-fifth of the participants indicate a break in their insurance, which is worrying. Irina Mitova, a master sociologist from IPSOS Bulgaria, emphasized that among people without health insurance, residents of smaller settlements, men, and people with lower incomes predominate. Only one in three respondents has additional health insurance, and these are mainly residents of Sofia and people up to 49 years old.

The study also reveals trends in Bulgarians' attitudes towards preventive checkups and visits to a general practitioner. 60% of respondents state that they undergo the mandatory preventive checkup annually. Nearly half of the participants believe that their general practitioner is a good professional. On average, the participants in the survey visit their general practitioner five times a year.

Another important aspect of the study is related to the prevalence of chronic diseases. Only 37% of respondents declare that they have no diagnosis. Among the other participants, the leading diagnoses are related to cardiovascular diseases, with hypertension being in first place, followed by diabetes, depression, thyroid diseases, oncological diseases, and asthma.

The study also raises serious questions regarding healthcare costs. More than half of the respondents report that they have to pay for a consultation because the doctor does not work under contract with the health insurance fund. Almost one in three pays for a consultation due to the long waiting time for an appointment. Every second person hospitalized indicates that they have paid extra for medical services, most often for examinations, high-specialized imaging diagnostics, consultations, or other fees imposed by the medical institutions.

Health expenses are an essential factor for the well-being of Bulgarian citizens. The study shows that every second Bulgarian takes medication, and nearly one in three takes dietary supplements. According to Irina Mitova, if prescription and over-the-counter medications are taken into account, monthly expenses can reach 200 BGN. In addition, another 140 BGN can be added monthly for checkups. The total amount represents a significant share of the household budget, especially considering that half of the participants in the survey live on an average income.

In the atmosphere of the conference, the topics of innovations and technologies in healthcare were leading. The Chairman of the Economic and Social Council, Zornitsa Rusinova, emphasized the importance of regulation and planning by the state, as well as the benefits of the introduction of technologies, but warned of the risk of increasing inequality.

Dr. Alexander Simidchiev, Deputy Chairman of the Parliamentary Health Committee, noted that in addition to innovations, good practices should also be applied. Assoc. Prof. Petko Stefanovski, Manager of NHIF, emphasized that forums like this are a place to generate ideas that will benefit everyone, with the ultimate goal being a better society. Dr. Nikolay Branzalov, Chairman of the Bulgarian Medical Union, commented that current challenges include the public financing of drug therapies, the treatment of socially significant diseases, and the implementation of artificial intelligence in medicine. Dimitar Marinov, Chairman of the Bulgarian Pharmaceutical Union, highlighted the role of pharmacists as drivers of innovation and digitalization, adding that the pharmacy industry is one of the most successful in the economy. He pointed out that identifying problems, acknowledging them, and seeking solutions are key to progress.

Tsvetelina Spiridonova, Deputy Chair of the Bulgarian Hospital Association, shared that innovations are eagerly awaited today, but expressed concerns that in the context of the political situation and the upcoming budget, they may be delayed. She also emphasized the importance of building a scale for the quality of health services.

Dr. Stoycho Kutsarov, founder of the Center for Protection of Rights in Healthcare, shared his observations on the development of the rights of patients and medical institutions over the years. He expressed disappointment that the protection of rights has not improved enough, which, according to him, is related to the restrictions on the freedoms of medical institutions, doctors, and patients. He pointed out that the lack of investment in the sector in the last year is worrying. According to him, innovations and investments are interconnected, and the increasing role of the state in restricting freedoms makes the system easier to manage, but also less effective.

Plamen Taushanov, Chairman of the Bulgarian Association for the Protection of Patients, emphasized that innovations should be provided by the state. He recalled that there is still no law on patients' rights in the country and assured that the association will propose a new bill.