Policy responses for Bulgaria - HSRM


Policy responses for Bulgaria

4.2 Entitlement and coverage

Testing, isolation, treatment, and transportation of all confirmed COVID-19 cases are covered either by the MoH’s Budget or the NHIF. First points of contact for patients who experience COVID-19 symptoms are GPs, emergency care units or the Regional Health Inspectorates. People at first and second line of contact with proved COVID-19 patients are tested as well. Screening is available to all who meet the case definition. PCR testing assigned by a physician is covered by the MoH regardless the health insurance status of the patient. Patients are monitored either by their GPs or the Regional Health Inspections at home. An order issued by the Minister of Health on March 16 regulates isolation and treatment at home and hospitalisation. Asymptomatic patients, discovered as contact persons to infected patients or in epidemiological surveys, and patients with mild symptoms without chronic conditions are subject to compulsory home isolation and treatment. All patients aged 60+ regardless their condition, as well as chronic patients, patients with moderate and severe symptoms, and those who cannot be isolated at home are subject to compulsory hospitalization.

Hospitalised patient are treated on an existing prior the pandemics clinical pathway “Diagnosis and treatment of contagious virus and bacterial diseases - sharpening, with complications” or on two clinical procedures – “Intensive treatment, monitoring and intensive care with mechanical ventilation and / or parenteral nutrition” and without mechanical ventilation and / or parenteral nutrition. The clinical pathway and the procedures are paid by the NHIF on a case basis and per day respectively. There are concerns among hospitals about being paid for COVID-19 treatment based on that clinical pathway because COVID-19 treatment requires much longer hospital stays than envisaged in the pathway and its flat (and very low) rate of BGN 618 (€ 316) is not sufficient to cover hospitals’ costs. Intensive care is paid by the NHIF per day on different rates depending on the case and the level of competency of the respective ICU.

Hospital treatment of uninsured COVID-19 patients is covered by the State Budget.
Laboratories provide testing to citizens on their request upon direct payments. Tariffs vary depending on the test and laboratory from BGN 30 (€ 15.3) for a rapid test to BGN 130 (€66.5) for a PCR test. Based on a supplement of the National Framework Contract singed at the end of April, the NHIF is going to pay for 96 000 PCR tests at rate of BGN 60 (€ 30.7).

At the end of November, with a supplement to the National Framework Contract (NFC), GPs were granted rights to issue referrals for PCR-tests covered by the NHIF. Previously, citizens had access to free-of-charge PCR tests after assignment by the Regional Health Inspections or by an outpatient specialist after permission was given by the NHIF. This highly restrictive procedure led to the underuse of the NHIF resources available for PCR tests. After the change in the NFC, GPs can assign a PCR test to each patient with at least two of 11 COVID-19 symptoms defined by the NHIF.

Sources and links:
National Health Insurance Fund, COVID-19 page; https://www.nhif.bg/page/2146 
National Health Insurance Fund, National Framework Contract; https://www.nhif.bg/page/57 
Ministry of Health, Orders related to COVID-19; https://www.mh.government.bg/bg/informaciya-za-grazhdani/informaciya-otnosno-noviya-koronavirus-2019-ncov/