The Bulgarian population is shrinking and aging. Bulgaria had a population of, approximately 7,930,000 in 2001 compared with 7,350,000 in 2011. The National Statistical Institute has also noted the aging of the population: only 15.9 per cent of the Bulgarian population is under 18 today, compared with 19.4 per cent ten years ago. Simultaneously, the population over 65 rose from 16.6 to 18.9 per cent between 2001 and 2011.

In response to that challenge, the National Reform Programme (2011-2015) of the Republic of Bulgaria introduces a number of reforms to the social security system to, in particular the health system.

These reforms are intended to improve the viability of long-term public funding and contribute to economic growth. The social security code has also been amended in line with this.

Three of the health measures will have a direct impact on the treatment of patients.

Developing e-health systems

A global information system will progressively be introduced to enable direct contact between the health facilities' information systems and contractors. The merging of the the information systems under the aegis of the Ministry of Health, will facilitate communication between the existing systems (Ministry of Health, National Health Insurance Fund, National Revenue Agency, National Social Security Institute, etc.) with health care providers (hospitals, outpatient centres and pharmacies). It will ensure a more coherent health policy, improved prioritization of activities, optimal and transparent funding of the sector and the rapid exchange of accurate information among all the stakeholders. More generally, the improvements will allow real-time monitoring and will thus help to ensure that decisions comply more fully with requirements.

Strengthening the management of the health sector

Reform efforts in this area are designed to transform and optimize regional health centres and regional inspection units for health monitoring and protection and will involve the creation of 28 regional health departments with new functions.

Improving access to medical care through:

- Guaranteed round-the-clock access to medical care for members of the health care system. Additional incentives will be provided for doctors working in teams and for specialists. New ways of organizing the work will also be introduced, providing patients with optimal access to medical care outside the hospitals and emergency centres.

- Quality indicators will be introduced in 2012 for more effective prevention and screening and better provision of health care. These instruments will be used to control expenditure on the most expensive outpatient treatments and hospital care.

- "Day Activities" (jour-activités) will be included in the basic package of hospital care to encourage the use of new techniques and treatment requiring minimal hospitalization. In addition to helping to reduce hospital expenditures, this measure should reduce the amount of sick leave.

- The mechanisms and conditions for the reimbursement of hospital emergency units will be improved to make them more efficient and improve the monitoring of their activities. Starting in 2013, the "Practical introduction to medical emergencies" project will work to improve the quality of emergency care, particularly for t most vulnerable groups, by enhancing the knowledge and skills of emergency care staff.

Legislation date: 04.2011

Date d'entrée en vigueur prévue: 01.2012