The Bulgarian healthcare system faces a number of challenges. In particular, the lack of nursing staff and problems with financing are causing problems for the EU country.
Bulgaria had the second highest per capita mortality rate after Peru during the COVID-19 pandemic, although Bulgaria ranked third in the EU in terms of the number of hospital beds according to official government statistics.
Bulgaria ranks third in the EU in terms of available hospital beds per person, but due to staff shortages, the mortality rate is still the third highest in the EU at 21.7 percent.
“Beds and medical equipment don’t heal patients. That’s the job of doctors,” said Venzislav Mutafchiysky, head of the Military Medical Academy in Sofia, one of the largest Bulgarian hospitals.
There is a particular shortage of nursing staff in Bulgaria. There are only 28,816 nurses for 29,604 doctors.
A “serious” problem in caregivers
According to Eurostat, the ratio of nurses to the population is the lowest in the EU – 6.9 per 100,000 people, with a third of working nurses being over 65. Ireland reports that 1.6 per cent of the population are carers, and in ten other EU Member States the proportion of carers is at least 1 per cent of the population.
In the 1990s, at the beginning of the democratic transition from communism to a market economy and democracy, there were 28,000 doctors and 53,000 nurses in Bulgaria.
Since then, the number of nurses has almost halved, with a 9 percent decline over the past decade. The number of doctors has declined slightly, but not as much as the number of nurses, and has been somewhat mitigated by an 11.5 percent decline in the population over the past 30 years.
The decline in medical professionals was particularly sharp after 2013, when restrictions on access to EU labor markets for citizens from Bulgaria and Romania were lifted and many went abroad to work.
A study by the Institute for Market Economy (IMP) finds that 2020 saw a sharp decline as well, attributed to the pandemic, the risks to older workers and the harsh working conditions.
The IMP noted that for the health system to function optimally in Bulgaria, the ratio between nurses and doctors should be at least two to one, which is still far from Finland, Luxembourg, Ireland, Switzerland, Iceland and Norway, where the ratio is over four to one.
The dwindling numbers are making it impossible to provide two nurses per shift at hospitals, meaning that often just one nurse can attend to more than eight patients.
Responding to EURACTIV’s request, the Ministry of Health informed that the main bottlenecks are in the areas of emergency medicine, internal medicine, general and clinical pathology, infectious diseases, paediatrics, epidemiology of infectious diseases, general medicine and otolaryngology. There are fewer than 70 coroners and about the same number of pathologists.
The number of general practitioners is declining and the workload is increasing. At the same time, despite the increased budget of the state health fund, Bulgarians pay up to 40 percent of the health services they use themselves. That is almost twice as high as the EU average.
Beyond all standards
One of the main reasons for this problem is probably the salary. Nurses in Bulgaria have an average monthly salary of 450 to 1,000 euros. Public hospitals are the most reliable employers, while private hospitals are not regulated, according to Nadezhda Margenova from the Union of Bulgarian Medical Specialists (SBMS).
She told EURACTIV that there are ways for carers to increase their income, but not all are viable.
“One possibility is to change jobs – so-called professional tourism. The other is working extra shifts, having second and third jobs, which degrades the quality of life and work. In order to earn extra money, the colleagues do not comply with the prescribed rest period after 12 hours of service. The second option is the life decision to give up your job or to emigrate,” says Margenova, who is a nurse herself.
dr Stoicho Katsarov of the Center for Health Protection Rights and former health minister said the solution is to limit government intervention, which has caused most of the problems.
“Countries with market-based healthcare systems have responded better to the COVID-19 pandemic,” he said. “The state distributes the money, regulates almost everything and thus restricts competition. He puts limits on hospitals that are practically their budgets, and the hospitals try to absorb them and nobody cares about the quality or whether people are actually treated in them,” Katsarov said.
According to him, salaries are determined by the market. Therefore, any attempt by the state to establish a basic wage for doctors is inadvisable.
The lack of a career development system was noted by Dr. Vanyo Sharkov, former deputy health minister. Speaking to EURACTIV, Sharkov explained that there is a need to differentiate funding and that more funding should be made available for the medical facilities that provide quality medical care, including emergency medicine.
“Right now the emergency room in Sofia is transporting patients to two or three medical facilities, which receive less funding than medical facilities that do not have an emergency room, and since all hospitals – both public and private – are funded on the same principle, so must they have emergency rooms,” he said.
So far, no political party has proposed solutions to the problems in the health system, including staff shortages.
Source : Euractiv
