Bulgaria facing health tax increase, as budget deficit risks Euro exclusion

Sofia: The Bulgarian Doctors’ Union is launching a campaign to increase the national health tax to compensate for deficits in the healthcare system.

A record healthcare budget of approximately €4.8 billion, an increase of 16% for the year, is planned for 2025. However, funding is insufficient due to sharply increased costs for medicines and hospitals.

“Money for healthcare is increasingly scarce, and hospitals need better funding to function. Increasing citizens’ health tax is not the best, but the only option,” the Bulgarian Doctors’ Union told Euractiv.

Bulgaria’s health tax is the lowest in the European Union, yet Bulgarian doctors must use the same equipment and medicines as their counterparts in other member states.

Health contributions in Bulgaria make up 8% of salaries and are covered by both employer and employee in a ratio of 60:40, specifically 4.8% and 3.2%, respectively. For comparison, health contributions in Germany are 14% and Romania’s 10%.

As Euractiv reported, pharmaceutical companies are urging the state to increase the drug therapies budget so that it does not rely on funding and discounts derived from private businesses.

The Ministry of Health told Euractiv that it would not comment on the health tax issue, as this would require a political decision by the ruling coalition in parliament.

“In order to increase the health tax for Bulgarian citizens, a political decision must be made, and a meeting of the responsible institutions, including the National Health Insurance Fund, must be held. After that, we can discuss how this can happen and how much the increase should be,” the Ministry of Health said.

In 2025, the Bulgarian government will face a budget deficit that may surpass 3%, jeopardising the country’s aspirations to adopt the Euro on January 1 2026.

The Bulgarian Medical Association argues that the timing for raising the health contribution is appropriate due to the growing incomes of citizens and the government’s need to reduce the budget deficit.

Increasing health contributions is a priority for Nikolay Brunzalov, the chairman of the Bulgarian Medical Association, who was appointed to the position in September 2024.

“All planned expenses under the National Health Fund’s budget for 2024 have been exceeded. At the same time, we see that they are trying to introduce new activities to be paid for by the Health Fund.”

“However, the health tax remains at 8%. Nowhere in Europe is there a fund that covers such a variety of health insurance payments with such a low contribution,” the Bulgarian Medical Union told Euractiv.

The medical guild insists that a public debate on financing the health system should be launched, setting the basis for a long-delayed reform.

The revenues from health contributions to the state budget are insufficient, as many Bulgarians pay minimal social security contributions.

Data from the National Statistical Institute for 2023 shows that one-third of working Bulgarians paid social security contributions in addition to the minimum wage (€390) at the time. As of January 1, 2025, the minimum wage has been raised to €550.

The Bulgarian Doctors’ Union announced that citizens will not have a truly solidarity-based healthcare system and will continue to pay for treatment out of their own pockets until healthcare financing reaches 10% of GDP. Currently, this share is 4.5%.

Bulgaria began a healthcare reform 25 years ago with the intention of increasing the healthcare tax to at least 12%, but this never happened.