Bulgaria is an eastern European member of the European Union since 2007 and a post-communist state. Compared to other members of the EU, it is seen as one of the poorer countries where a lot of funds and subsidies are spilt, in order to boost its economy and bring up its level towards the higher end of the developed countries.
In this essay, I will mainly focus on its health related issues, and the issues created by the corrupted state. With a health care budget of 4.3 percent of GDP or USD $2.2 B in 2018 (Bulgaria Healthcare and Medical 2018), the healthcare in the state could be much improved dramatically and the money could be spread more evenly and fairly across the many diseases the population suffers from. The purpose of mentioning that is correlated to corruption getting in the way of receiving the proper treatment and how in a country with an aging population, most pensioners cannot afford basic treatment that otherwise is promoted as accessible. I will also focus on diseases and how the government policy tries to deal with them, and what are the results so far. For the last part of my topic, I would like to address the behavioural factors that affect the Bulgarian population by mass and by that I mean smoking, drinking and the use of narcotic substances in a state where having those habits, by the age of 15, is considered something not so disturbing.
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In 1998, Bulgaria introduced a centralised SHI system, a decision that ran in parallel with the country’s transformation from a centrally planned economy to a market economy. Due to this all citizens of the country are required by law to obtain insurance which provides them with free health care(State of Health in the EU Bulgaria 2017). Although this is the case, certain diseases and services are not covered by the insurance or have long waiting lists that could take up to months. From my personal experience, in order to go through a nuclear magnetic resonance to get checked for cancer, a typical Bulgarian has to wait to up to six months. If you want to survive and stand a chance against the disease, you get recommended to pay 300 euros and will get the service within a day. For most of the population this is not an issue, especially when it comes to one’s health, but for our aged population this remains the biggest challenge.
The average pension for men is 410.58 leva, and for women - 298.48 leva (Men in Bulgaria Receive 38% higher Pensions than Women 2018). To put this into perspective, men receive 205 euros when retired monthly and women about 150 euros. With medicaments having the same prices as in Western Europe and basic needs such as food and clothes being only 20% cheaper than a country like Austria, you can imagine how the elderly survive. Those without the help of their working children simply do not; health care for people in remote villages is too expensive and non-existent, people use their own knowledge when they fall sick and if they turn up at a hospital, most are told that the treatment will cost a fortune. This is the sad reality that faces us as the new generation of this country. Many doctors and well specialized experts leave Bulgaria to go to Germany or UK and who would blame them when the average salary in the country is about half of what they would receive in those developed countries. Those who choose to stay often work for private clinics or centres that charge money and are not covered by the health insurance. This is due to the higher pay in private clinics and the better working conditions that satisfy our doctors. At the end of it all, we can see how our free health care system, in fact is not so free. How reforms at a very high level need to be done for a system that is simply not functioning the way it should do. As a result of those factors, Bulgaria has the second lowest life expectancy at birth in the EU with 74.7 years (State of Health in the EU Bulgaria 2017). It is not the lack of free health care that causes this alone. Public hospitals are very much since the communist state, equipment in most hospitals has not been changed since 40 years and the sanitation in those clinics is not at its best. Some might argue it is the doctors to blame for some of those faults, but in fact the health care system needs a lot more funding than it actually receives. This money has to come from taxpayers in Bulgaria and with a declining workforce that migrates across Western Europe and an aging population; it is not hard to say that this task is simply impossible. The health system functions with the little it has and although there are states in the world with worse systems, there is for sure room for improvement. The EU does help our government with a lot of funding and despite this, many funds are misused and do not reach the ones that actually are in need. Corruption continues to stand in the way of Bulgaria becoming a developed country as it is considered the most corrupted state at all levels in the European Union up to this date (Is Bulgaria Really as Corrupt as the Headlines Would Suggest? 2018)
Bulgaria is a country where infectious diseases are not so common, although the government does not do quite as much as the Western European states. However some of these do prevail and have increased in popularity amongst the population in recent years. For a fact the incidence of tuberculosis in Bulgaria has dropped by 38% in the years from 2000 to 2014 and is now bellow the European average for the infectious disease (Bulgaria Profile of Health and Well-being, World Health Organisation 2017). This kind of data is quite promising and has been achieved by the vaccination for tuberculosis being compulsory for all children and adults. However, HIV positives in the state have increased by more than five times between the years of 2000 and 2014. Although this was the case, the infected were 3.4/100000 which is still below the European average and certainly below the average of the Balkan region where the data shows there are 13.7 infected per 100000 of the population(Bulgaria Profile of Health and Well-being, World Health Organisation 2017).. Parallel to the increase of HIV positives, the incidence of AIDS increased by 4.5 times in that same period. The data, taken from the World Health Organisation, shows that the rate in 2014 was 0.9/100000 and was below the average for the region and in line with the European standards, moreover vaccinations for Measles and Poliomyelitis have remained at the rate of above 90% and have even increased. This of course helps to say that the case of these diseases being registered in the territory of the state will be extremely rare and considered an epidemic.
Although Bulgaria deals effectively with its infectious diseases so far, the country seems to be struggling with tackling another kind of disease. “The 2013 incidence of cancer (461.9/100 000) was lower than the average for the EU13 (508.3/100 000) and higher than the average for the Region (426.3/100 000)”. This data, taken from the research on Bulgaria, done by the World Health Organisation, is not so promising. Cancer is a deadly disease and if not caught on time, it often ends fatally for the patient. The reason for the increase is the lack of opportunity for patients, for instance health checks and a simple sample of blood being tested are not covered by the insurance. For this reason many Bulgarians choose to visit a doctor only when something goes wrong, and in many cases it may be too late. Equipment is old and simply not enough to cope with the amounts of patients and also treatment for cancer in Bulgaria does not come cheap either. Chemotherapy isn’t covered by the Health insurance and medicaments such as morphine also do not come at a low cost. For many citizens, living close to the poverty line, these factors leave them with no choice, but to hope for a miracle. From personal experience, I could state that many patients diagnosed with cancer choose to be treated in other countries, such as Germany. The Health system of this member of the EU is simply outdated and the data shows that the methodology used to prevent and treat the disease is simply not working. This is not the only factor that leaves so many Bulgarians diagnosed with cancer. Behavioural factors play major role, such as smoking, drinking, the abuse of narcotics and the unhealthy lifestyle a person could have.
Top five of the main contributors of overall mortality are heart diseases, stroke, ischaemic heart diseases, lung cancer and colorectal cancer. “The prevalence of smoking in the Bulgarian population is the highest in the EU and nearly seven percentage points above the EU average”. This citation is taken from a report done by the European commission in 2017. The effect of excessive smoking habits is well known; heart and lung diseases follow after the abuse of tobacco. Therefore, it does not come with a surprise that exactly these diseases are the main mortality causes for the population. Children at high schools start smoking at the age of 15; this of course takes them into an addictive cycle that could lead into the abuse of stronger narcotic substances in their later life. Nicotine is extremely addictive and cigarettes are very accessible as they are nearly half of what they cost in Western European states. The government does not do enough to educate our children on what are the effects of tobacco and it is somehow considered “cool” among the youth population. In my opinion, placing higher taxes on those products and making them less affordable, will have a major impact on this issue. Furthermore compulsory seminars in schools will educate young adults on what happens when you choose to consume tobacco and the health disadvantages.
On a much brighter side, however, according to the European commission, Bulgarian kids are among the most active in the Union. The obesity status of the population is well above the average of the more Westernised countries, but also in the binge drinking among adults. Although the research of the European commission does show some positivity, it is not something that will drastically change the situation our health system finds itself upon. Bulgaria is indeed among the first three lowest spenders when it comes to health from the whole EU. Furthermore, the report shows that a lot more funding is needed to catch up with the more economically developed countries.
“The level of out-of-pocket payments in Bulgaria is the highest in the EU. Indeed, out-of-pocket spending accounted for 48% of health expenditures, compared to a 15% average in the EU” (Bulgaria Healthcare and Medical 2018).
Here comes the big dilemma for our government, not much is being spend on our health system. With the low purchasing power of the Bulgarian population, we still manage to spend most on health out of the whole EU. From this it can be said that indeed our health care is not so free at the end of it all. Should we spend more of our GDP towards health or should we rely on a similar system to the Americans, where every health benefit is paid for? After all, with a GDP growth rate of just 3.2% (Trading Economics 2017), there is not much that can be done in the short run. In my opinion this is the major problem of this system, every government expects for more funds in the future years to come, in order to make reforms in our health care system and produce something that will work for the benefit of the people. However, this is not the case as funds cannot be found and for the past decade our GDP has been fluctuating within the 55 billion mark. The healthcare of a state depends well upon its economy; I can name Austria as a great example for that - a relatively small country with a strong economy and a much more developed health service system. After all, there is still hope within our society - the country has come a long way since the communist era and improvements can be seen in year to year bases. Migrants are now returning to their home country and the population seems to once again be increasing. These factors can only leave our health care budget on a positive note as there will be more taxpayers to contribute towards the slipping economy and work towards the renewal of our aged health care system.