Overview

This report is the first comprehensive analysis of financial protection in the health system in Bulgaria. It covers the period from 2005 to the present day. Drawing on microdata from household budget surveys carried out by the State Statistical Office, the report’s key findings are as follows. In 2018 about 8% of households in Bulgaria were  impoverished or further impoverished after out-ofpocket payments. 19% of households experienced  catastrophic health spending. The people most likely to experience catastrophic health spending are those in the poorest quintile, older people and households in rural areas.  The incidence of catastrophic health spending has grown over time, pushed up by a large increase in the poorest quintile. On average, the health services most likely to lead to catastrophic health spending are outpatient medicines, medical products and inpatient care (Fig. 2). In the poorest households, financial hardship is almost entirely driven by outpatient medicines.