Restrictions on access to medical care for the uninsured in Bulgaria

INTRODUCTION: There are two forms of health insurance in Bulgaria - mandatory and voluntary. Despite the fact that all Bulgarian citizens are required to have health insurance, a high proportion of persons with interrupted health insurance rights due to irregularly paid health contributions is reported every year. These persons have limited access to health services, as they cannot be provided with free preventive activities, planned hospitalizations, and for pregnant women there is a minimum number of free examinations (4 examinations during the entire pregnancy). The purpose of the present study is to determine the share of persons with suspended rights and their opportunities to access health services. METHODS: Official data from the annual reports of the Health Fund and the National Statistical Institute for the period 2020 - 2022 for the Pleven region were used. The data were processed with statistical methods. RESULTS: It was found that for the period from 2020 to 2022, an average of 20.6% of the population had interrupted health insurance rights. Provided that persons under 18 and those of retirement age are insured by the state, persons with suspended rights are only of active age. Among this group, the share of the uninsured is 34%. Uninsured women giving birth in 2020 are 19.35% of all women giving birth, in 2021 - 16.54%, and in 2022 - 18.33%. CONCLUSIONS: The high share of persons with interrupted health insurance rights in Bulgaria represents a serious problem for the access to basic medical care of these people. Limitation of activities for prevention, planned treatment and regular monitoring of pregnant women. poses a risk to both their individual health and the health of the population. KEY MESSAGES: • In Bulgaria, a high proportion of persons with interrupted health insurance rights is observed. • The uninsured have very limited access to free medical care, preventive activities and planned treatment.