What Would it Take to Improve the Health System in Bulgaria?

October 3, 2014


Agnès Couffinhal, World Bank Senior Economist and presenter at the conference.

Photo: Nadezhda Chipeva, Capital Weekly

  • People in many countries around the world ask similar questions when it comes to healthcare systems: how should these systems be financed? How should they be organized? Are the patients paying a fair price? How do we ensure that people can adequately afford health care?
  • The First Annual “Innovations and Good Practices in the Health Sector” Conference in Bulgaria brought together key policy makers and stakeholders to seek answers to these problems and discuss what can be done to improve the country’s health care system.
  • One key conclusion from the conference was that, while no magic recipe exists to solve these problems, paying attention to a core set of ingredients can help develop lasting solutions.

There is no recipe, but ingredients matter - according to the World Bank, at the First Annual Conference on “Innovations and Good Practices in the Health Sector” 

Nearly everyone who interacts with the health care system in Bulgaria ends up wondering: is the system underfunded? Is it organized in a way which provides the best possible quality given the resources available? Am I paying a fair price for the health services and drugs I receive?

On September 24th, 2014 the Capital Weekly newspaper organized a conference to debate these exact questions. The one-day event titled First Annual Innovations and Good Practices in the Health Sector Conference brought together more than 100 policymakers, representatives of different health organizations, medical professionals, representatives from the pharmaceutical sector, and different patient organizations. The conference looked to highlight good practices in the health sector and suggest solutions for improving the effectiveness, accessibility, and resilience of Bulgaria’s healthcare system in the context of the National Health Strategy 2014 - 2020 and the European Commission Communication on health systems organization.

A World Bank team of experts, led by Tony Thompson, Country Manager for Bulgaria, Czech Republic, and Slovakia, also contributed to these discussions - adding one important aspect to all the questions raised by the participants, namely: how to ensure that people vulnerable to poverty do not bear an unreasonable financial burden when they access necessary health services in the country.

" The World Bank has been partnering with Bulgaria for 22 years. During this time we have provided funding for investments along with ideas for reform. The way I see our role in Bulgaria now is not to provide recipes, but to first start with a diagnostic. Once we have evidence-based information and data we can then highlight some examples of how underperformance has been successfully tackled in other countries. "
Tony Thompson

Tony Thompson

Country Manager for Bulgaria, Czech Republic, and Slovakia

Agnès Couffinhal, World Bank Senior Economist and featured presenter at the conference, highlighted three key ingredients often found in countries which perform better than Bulgaria.

“Patient-based provider payments, provider autonomy, and the use of information for decision-making – these ingredients have to be organized coherently in order to ensure the accountability of service providers,” Couffinhal emphasized.

In April of this year, the Bulgarian government engaged the World Bank through the mechanisms of reimbursable analytical and advisory services for the health sector, focusing on health financing. Under the agreement, the World Bank will analyze how funding flows through the health system in the country and the extent to which this is organized in a way that contributes to achieving important goals - such as ensuring access to healthcare in an efficient and affordable way.

Two aspects of this work will be given specific attention: the hospital payment system, which is slated to undergo reform, and pharmaceutical policies. The entire work will factor in the fiscal outlook of Bulgaria to enhance long-term sustainability. Ultimately, the work will support the Government as it prioritizes the ambitious reform program laid out in the National Health Strategy 2014-2020.