Bulgaria

A member of the Soviet bloc, Bulgaria is still in the process of transitioning from a state-controlled system to a democratic, free market economy. Inflation (5 percent) and unemployment (11.5 percent) have combined with corruption and organized crime to drain important resources from the government that are needed for healthcare and other social programs. Bulgaria ranks 89th in world incomes, with a per capita income of $9,600. The Gini coefficient for Bulgaria is 31.9 percent, and income is somewhat unequal, with the richest 10 percent of the population claiming 22.8 percent of resources while the poorest 10 percent share 4.4 percent. Eleven percent of the population are engaged in agriculture. Approximately 13.4 percent of Bulgarians live in poverty, and 5 percent of the population live on less than $1 a day. By some estimates, 90 percent of the population is classified as low-income. Women and children are particularly vulnerable, and 65 percent of female-headed families live in abject poverty. Elderly women are three times more likely than men to be poor.

The Bulgarian government designates 12 percent of the total budget and 7.5 percent of the Gross Domestic Product (GDP) for health expenditures. Some $573 (international dollars) per capita are used to fund government healthcare programs. Of all government expenses, 54.5 percent derive from government subsidies. Over half of that amount (51.6 percent) is earmarked for social security. The private sector furnishes 45.5 percent of health expenditures, and out-of-pocket expenses account for 98.40 percent of that amount. There are 3.56 physicians, 3.75 nurses, 0.55 midwives, 0.82 dentists, and 0.13 pharmacists per 1,000 population in Bulgaria.

According to the Public Health Act, all Bulgarians have equal rights within the healthcare system. Special programs deal with the healthcare needs of [Page 318]pregnant women and mothers with children who receive public assistance. Overseeing the health needs of children is the joint responsibility of the Minister of Health, the Minister of Education and Science, and the Minister of Labor and Social Policy. Specific programs are administered by local communities. Social security is financed by contributions from employers and employees supplemented by the government.

Despite legal equality, informal payments for healthcare are a way of life in Bulgaria, and gifts and cash payments are considered universal for operations, childbirth, and life-threatening situations. Such payments are expected and may be demanded in hospitals and elite facilities and by noted physicians. Medical professionals depend on such payments to supplement income, but they can present problems for those with few resources who are able to receive quality care only through submission of such payments.

Among the population of 7,385,367, life expectancy is 72.3 years. Females tend to outlive males by about seven years. Literacy is high at 98.6 percent, and 90 percent of Bulgarian children are enrolled in primary school. All males and 97.8 percent of females are enrolled in secondary school. One hundred percent of the population has access to safe drinking water and improved sanitation. Bulgarian women give birth to an average of 1.38 children each, and 42 percent use birth control. Only 1 percent of all births occurs outside the presence of a skilled attendant. The adjusted maternal mortality rate is 32 deaths per 100,000 live births.

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