Mimi Vitkova: The healthcare system is driven to the brink; patient costs are among the highest in Europe

The new requirement for private hospitals to conduct public procurement when purchasing medicines is a step in the right direction, but it is overdue. This was emphasized by Dr. Mimi Vitkova, the former Minister of Health, commenting on the changes in the sector.

According to the expert, such measures are recommended by the European Commission to level the playing field between state and private medical facilities. However, she adds that the process should be broader and cover not only medications but also all medical equipment and apparatus funded by public funds.

One of the most serious problems Vitkova points out is the lack of effective control over the prices of medical devices. She highlights the absurd difference in the costs of the same consumables in different hospitals – for example, the same stent can cost 2,000 BGN in one facility and 5,000 BGN in another, even though the quality and manufacturer are identical.

While mechanisms for regulation exist for medicines, control is practically non-existent for implants and consumables. This leads to enormous out-of-pocket payments from citizens. "Nowhere in Europe is there such a high co-payment from patients. In our country, it reaches about 40% of all healthcare costs," stated Dr. Vitkova, citing examples of sums reaching tens of thousands of levs for individual procedures.

The former minister's criticism is also directed at the structural inefficiency of the system. She notes that although the number of hospitals in Bulgaria has grown significantly from 144 in 1997 to over 340 today, this has not led to an improvement in health indicators. On the contrary, the system encourages over-hospitalization, as the revenues of medical facilities depend directly on the number of admitted patients.

Regarding personnel, Dr. Vitkova believes that the problem is not the absolute number of doctors, but their uneven distribution. While large cities are saturated, entire regions remain without access to key specialists, with a particularly acute shortage observed among nurses, pathologists, and pediatricians.