No Care at Bulgarian Hospitals

When entering the Pirogov General Hospital in Sofia, the first thing you notice is the full waiting room. People wait for everything, for a prescription or an appointment, to visit a relative, or even for emergency care.  Nothing happens fast. Only few staff is present and they are obviously overworked. This is the oldest and largest hospital in Bulgaria, founded in the 1950s by the last Bulgarian king, Boris I, designed to handle 1,005 patients. It is currently overcapacity by some 40%.

To make matters worse, much of the care goes unpaid, leaving the staff increasingly frustrated. Doctors’ earnings have been dropping steadily, falling from 260 Euro to 235 Euro per month in the first quarter of 2006. This is still above the average wage of 150 Euro, but far below what doctors make elsewhere in Europe. The situation came to a head in mid July, when Bulgarian doctors threatened to strike if there wages were not raised.

Two-hundred doctors in total signed the document supporting a strike, although strikes by medical workers are against the law in Bulgaria. Hospital director Petar Ivanov clarified a statement to the Bulgarian National Press, which consists of a network of all Bulgarian media outlets. Although he committed to resolving the situation as quickly as possible, few expected he would make big changes. Still, he was able to raise the wages by 5%, after a new agreement had been reached with the Ministry of Health.

While health care financing is under pressure in many countries, the crisis in Bulgaria reflects the particular complexity of maintaining public services in the often struggling economies of post communist countries. Bulgaria’s doctors are widely respected as some of the best trained in Europe, yet without proper facilities, state of the art equipment or adequate pay, it can be next to impossible to provide quality care. However, the Bulgarian public is convinced that inadequate government funding and disorganized distribution of resources have thrown the system into a chaos of poorly regulation that results in many threatening medical conditions going untreated.

"Things have changed a lot since the fall of communism in 1989; when the biggest insurance companies had merged," says Dr. Ivan Dimitrov. The fifty-year-old surgeon made a successful transition to the private sector ten years ago when he opened his own clinic. Before that, he had been working in the hospital Pirogov.

He has no regrets about leaving.

"In such financially critical times, the people who suffer most are the medical doctors in Bulgarian hospitals. I was lucky, and was able to grab an opportunity when it came. But many young people devote their lives to being medical scholars, and get bitterly disappointed when they are not able to feed their families from the poor salaries."

The reason for this rapid decline is the plight of emergency medical services. People who need an ambulance and are later discharged, do not get reimbursed by their insurance companies. The companies will only pay if the patient is actually admitted to the hospital for inpatient care.

Most emergency room patients at Pirogov have had severe injuries. And the numbers are going up. In the first few months of 2006, admissions for this type of patient rose by 40%, making the hospital even more dependant on insurance reimbursement than ever. And while the hospital does get support from the state, Petar Ivanov says that the insurance reimbursements the hospital receives are far from sufficient to cover costs.