Hospitals in Bulgaria are warning the government of a potential wave of bankruptcies if mandatory salary increases for healthcare staff are enforced. The proposed wage hikes are seen as a threat to the hospitals’ ability to purchase necessary equipment and medications.
A collective labor agreement in Bulgaria’s health system mandates minimum pay levels, which are the lowest in the EU, set at €1000 for doctors, €750 for nurses, and €460 for orderlies. Despite this, some hospitals have not met these minimum wage levels, leading to union threats of protests by the end of May. Hospitals failing to comply with the wage requirements face fines for each violation.
“With these overwhelming financial burdens imposed for populist reasons, hospitals will inevitably be forced to lay off some of the staff, limit other expenses—for investments in new equipment, for drugs and consumables—which will lead to less income, affect the treatment of patients, and subsequently to a real risk of bankruptcy,” stated associations of municipal, university, and private hospitals in Bulgaria.
Chronic Underfunding
Bulgaria allocates approximately 4% of its GDP, around €4.1 billion annually, to its health system, which suffers from significant underfunding and structural deficits. The low salaries deter sufficient numbers of nurses, resulting in a higher number of doctors than nurses in Bulgarian hospitals. Despite staff shortages, Bulgaria maintains the highest number of active hospital beds in the EU, even surpassing Germany, which contributes to inefficiencies and a focus on state fund absorption rather than quality care.
Private Payments Rival State Funding
A pressing concern is the potential shutdown of the Strategic Children’s Department of the National Cardiology Hospital in Sofia due to a nursing shortage. This department is the only facility in Bulgaria performing surgery on children with congenital heart malformations.
Over the past decade, Bulgaria’s health system has heavily relied on private payments from patients, which approximately match state funding at €4 billion. The grey economy exacerbates the healthcare funding problem, with about 20% of working-age Bulgarians employed in the informal sector, thus not contributing to mandatory health insurance.
In 2023, the government attempted to curb the emigration of Bulgarian medical staff to other EU countries by intervening directly in the health sector to raise staff salaries. However, many state and municipal hospitals have refused to increase nurses’ salaries to the minimum levels, citing budget constraints.
Call for Wage Increases Amidst Financial Strain
Health unions are advocating for a 25% increase in basic wages over the agreed minimum levels, threatening protests that could disrupt hospital operations. Data from the National Statistical Institute for the first quarter of 2024 indicates the average salary in Bulgaria’s health system (before taxes) is €1,110.
Health Minister Galya Kondeva announced on May 27 that the government proposes maintaining the current minimum wage levels for another year.
Bulgaria’s stance during the EU pharma package negotiations highlights concerns over rising healthcare costs. The country is pushing for the new EU pharmaceutical legislation to include mechanisms for the purchase of innovative drug therapies by countries with lower GDPs.
In a significant development, Bulgaria’s Constitutional Court ruled in April that administrative limits imposed by the state on hospital treatments financed by the state health fund are illegal. This decision is expected to lead to increased costs for the state health fund, particularly for treatments in private hospitals, which the Ministry of Health cannot financially regulate.
Related topics:
- What is Prostate Swelling: A Comprehensive Guide
- Can Women Take Centrum for Men? A Comprehensive Guide
- Enlarged Prostate in Young Men: Causes, Symptoms & Treatment
