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Health Economics and Management

Hospital care in Bulgaria - trends in expenditure and activity

Pamela Penyovska, Stela Kyuchukova, Antoniya Dimova


Introduction: Hospital care extensive development in Bulgaria after the introduction of health insurance system is perceived as a significant problem. Hospitals consume substantial financial resources and the rapid increase in hospitalizations evidences both hospital and outpatient care ineffectiveness. The aim of the study is to analyse hospital care development in Bulgaria for 2000-2016 from the perspective of resources involved and activity.

Materials and methods: Data by the WHO GHE-DB, NSI and NCPHA on expenditure, number of hospitals and beds, and hospitalizations by sector (public and private) and in total is used. Structural and trend analyses are applied for the data interpretation.

Results: Total health expenditure increased 3.5 times in 2000-2015 from 3,057 million PPP$ to 10,745 million PPP$, as the increase per capita was 4 times. Expenditure for hospital care were 2.5 times higher in 2015 compared to 2003. In contrast with public hospitals and beds, which decrease by 17.8% and 45.4% respectively in 2015 compared to 2000, the number of private hospitals increased 6 times and the beds increased 34 times. In 2016, public hospitals decreased by 6 and beds were reduced by 2.3% compared to 2015, while the private sector was enlarged with 3 hospitals and 799 beds (7.7% increase). Hospitalizations increased 1.8 times in 2015 compared to 2000 with a 74 times increase of the private hospitals only. This tendency continued in 2016 and private hospitals` admission as a share of total hospitalizations increased from 26.3% in 2015 to 28.3% in 2016. The average expenditure per hospitalized patient increased by 54.3% in 2016 compared to 2003.

Conclusion: Extensive development of the hospital care in Bulgaria in 2000-2016 is mainly due to the private sector development. The total hospital expenditure increased mostly due to the increase of hospitalizations rather than to the increase of the expenditure per hospitalized patient.


hospital care; hospital expenditure; number of hospitals; hospital beds; hospitalizations; Bulgaria

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