Introduction: Regional inequalities in primary care expenditure have important implications for equity and overall system performance. Evidence on how primary care expenditure varies by region over time remains limited in Bulgaria.
Aim: The aim of this article is to examine trends and regional disparities in National Health Insurance Fund (NHIF) expenditure on primary medical care in Bulgaria and to measure the level and evolution of inter‑regional inequalities.
Materials and Methods: A longitudinal ecological study of NHIF data on primary medical care expenditure per 100 insured persons across Bulgaria’s 28 regions (2010–2024) was conducted. Nominal values were deflated to 2010 prices using the healthcare-specific Consumer Price Index, and national trends were analysed with linear regression. Regional inequality was analysed using the coefficient of variation (CV), rate ratio, and rate difference, while sigma‑ and beta‑convergence were assessed with linear regression models.
Results: National average NHIF expenditure increased significantly, rising by 299.5% in nominal terms and 232.8% in real terms between 2010 and 2024. Over the same period, the CV increased from 5.3% to 7.1%, the rate ratio peaked at 1.44, indicating widening regional dispersion. Sigma‑convergence analyses showed significant divergence in both nominal and real terms, driven mainly by the pre‑pandemic years, while beta‑convergence was absent, implying no catch‑up of initially low‑spending regions.
Conclusion: Although NHIF expenditures rose markedly, this increase did not close the gaps between low‑spending and higher‑spending regions. These patterns suggest that existing payment arrangements and workforce distribution have not ensured equitable regional resource allocation and highlights the need for targeted measures addressing under‑served regions.
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