Bulgarian National Report, October 2024
Political Instability and Frequent Government Changes
The Board of Directors of the Bulgarian Medical Association (BMA) was elected in 2021 for a three-year term, during which from 2021 to 2024, Bulgaria held numerous early elections, resulting in six different governments, four of which were interim. During this period, five different Ministers of Health were appointed. There were also several changes in the leadership of the National Health Insurance Fund (NHIF), the main payer in the healthcare system, which further complicated the functioning of the healthcare system.
For example, due to the political crisis, the National budget, including that of the NHIF for 2023, was adopted with an eight-month delay. This also delayed the signing of the National Framework Agreement for Medical Services (NFA) for the 2023-2025 period. Negotiations on this agreement went through numerous conflicts between the BMA and the NHIF, reaching a boiling point when the BMA withdrew from the negotiation process in November 2022, demanding the resignation of the leadership of the NHIF. One of the main conflicts between the BMA and the NHIF was related to determining hospital budgets based on the average monthly values from 2021, rather than the actual volume of medical services provided. This caused dissatisfaction among hospitals and doctors. The BMA demanded a significant increase in the prices of medical services, negotiating an average increase of 25% for hospital care and 30% for outpatient care (including primary and secondary examinations, and preventive care).
In 2022, the BMA managed to negotiate a significant salary increase in various healthcare sectors. In hospital care, the increase reached 25%, while in outpatient care, it was 30%. These increases were applied retroactively from January 1, 2022, bringing some stability to the remuneration of medical staff.
The BMA continued to address the issue of violence against medical professionals with its campaign "A Good Word Heals," following the "Overcome Anger" campaign. The BMA signed an agreement with the Prosecutor's Office for the rapid investigation of acts of aggression against healthcare workers.
One of the undisputed achievements of the BMA during its term was the acquisition of a new building for its headquarters. In April 2023, the new building on Dospat Street 2 in Sofia was officially opened, featuring three conference halls named after prominent Bulgarian physicians.
The BMA commissioned the first-ever study on the economic contribution of healthcare sector in Bulgaria. It demonstrated that the healthcare sector ranks among the top five employers
in the country, with around 106,000 employees with annual salary amounting to nearly 2.8 billion BGN. In conclusion, the 2021- 2024 period witnessed political instability, continuous negotiations and conflicts between various institutions, which the BMA successfully navigated and brought some improved conditions for medical professionals.
The delegates of the 77th Assembly of the Bulgarian Medical Association (BMA), held on the 28th of September 2023 elected Dr. Nikolay Branzalov as Chairman of the Bulgarian MedicalAssociation 252 votes out of 403. Dr Branzalov will serve as Chairperson for a three-year mandate. Dr Branzalov has been longterm representative of BMA at CPME. The outgoing chairman, Dr Ivan Madzharov, who served two consecutive terms, is elected as Deputy Chairman of the BMA.