Overview
In Bulgaria there is a National health insurance fund which is formed by contributions payable by all persons working on labour contracts. Additionally one may have a contract with voluntary health insurance fund by paying voluntary health insurance.
What happens if you need to see a doctor?
The first thing to do is to go to your personal GP (if you are not covered by the national health insurance fund, you can only go to emergency hospitals when in need). The GP can decide to send you to see another medical doctor or do some medical checks (with referral by giving you a special document – these are limited in number). For example, a person living with diabetes can see their endocrinologist 3 times per year for consultation or for checks like HbA1C, eyes, etc. They can go to their GP any time they need and every month for the prescription of insulin.
Who decides what medicines a doctor can prescribe?
The Ministry of Health, National health fund and National agency for Medicines are the regulators. There are guidelines for good medical practice which provide criteria for making choices for prescribing one insulin or another.
Practically, what is it like to live with type 1 diabetes in Bulgaria?
Insulins are fully covered by the National Health fund. They are prescribed by the endocrinologist for periods of 6 months with a document called protocol which has to be validated by the National Health fund. Test strips are 150pcs per year and free of charge for patients under 18 years of age. Ketone strips and needles must be paid for out-of-pocket. Insulin pumps are very expensive and not covered by the National Fund. For reference, in Bulgaria one pack of test strips costs 48 BGN and the minimal monthly salary is 340BGN. Therefore, for many people buying them it is unaffordable and leads to bad control.
What about getting admitted to hospital?
By referral of GP or endocrinologist, someone can be admitted to hospital for adjustment of medical treatment. Medical care is free of charge, only small daily fees are paid by patients.
How does diabetes care vary throughout the country?
The diabetes care varies a lot. There are endocrinology clinics with highly professional diabetes experts, but only in the big cities. In theory, insulins are prescribed based on standardized criteria and there should be not a difference in terms of insulin based on geographical principle. Pumps and CGMs are not relevant for comparison as they are mostly unavailable.
Thank you very much to Rossitza Handjiyska for helping us with information about diabetes in Bulgaria.