Dear Minister, Deputy Ministers, distinguished guests,
I’m delighted and thrilled to be addressing you today.
Delighted because our World Bank team of experts delivered on the important task to look closely into Bulgaria’s heath financing. We have been negotiating our knowledge support to Bulgaria with 4 consecutive governments and we discussed with every government where we could bring most expertise. The contours of the current Reimbursable Advisory Services were redefined many times but one thing remained constant: taking a close look at the health financing in Bulgaria.
We see our role bringing a global perspective in combination with data and evidence to provide our member countries with the information and analyses they need to take good decisions on policy and implementation. We trust that we have succeeded in providing this for you.
And I am thrilled to learn more today about this important topic. As you know: money matters! But from I’ve heard from the team they’ve struggled to solve a puzzle: many of the pieces of the puzzle in Bulgaria are well crafted but the overall picture which emerges when you put these pieces together is that the system is not performing the way it should.
My colleague Agnès will present the work and what we have done in more detail, and this conference is dedicated to talking about it but let me describe to you just a few parts of the puzzle, namely:
- Bulgaria’s health system is good and has strong and sound fundamentals.
- Total Bulgaria’s spending for health (8% of GDP) is above average given Bulgaria’s income level; the public spending is average compared with other countries.
- Given all this, however, the health status of Bulgarians should be higher. On the other hand the financial protection is poor as 4% of Bulgarians become poor each year because of out of pocket payments. These payments are 47% of the total health spending in the country – over double the 20% threshold defined by the World Health Organization.
- There are tremendous cost pressures and financial sustainability is endangered.
- Yet, in many ways, the health financing system is organized in a way which should allow it to deliver good performance. In particular, the overwhelming majority of the population is covered by a single insurance fund which is in a position to purchase services strategically from a range of providers.
So, why is the system not delivering better performance?
That’s what we are here to discuss – the devil in the details – improving health financing performance does not necessarily require big-bang reforms but it requires courageous and consistent effort to put all parts of the puzzle in the right place. All of you are here today because you care, and you are also part of the solution.