Hospital care in Bulgaria - trends in expenditure and activity

Introduction: Hospital care extensive development in Bulgaria after the introduction of the health insurance system is perceived as a significant problem. Hospitals consume substantial financial re­sources and the rapid increase in hospitalizations evidences both hospital and outpatient care inef­fectiveness. The aim of the study is to analyze hospital care development in Bulgaria for 2000-2016 from the perspective of resources involved and activity.Materials and methods: Data by the WHO GHE-DB, NSI and NCPHA on expenditure, number of hospitals and beds, and hospitalizations by sector (public and private) and in total is used. Structur­al and trend analyses are applied for the data interpretation.Results: Total health expenditure increased 3.5 times in 2000-2015 from 3,057 million PPP$ to 10,745 million PPP$, as the increase per capita was 4 times. Expenditures for hospital care were 2.5 times higher in 2015 compared to 2003. In contrast with public hospitals and beds, which decreased by 17.8 % and 45.4% respectively in 2015 compared to 2000, the number of private hospitals increased 6 times and the beds increased 34 times. In 2016, public hospitals decreased by 6 and beds were reduced by 2.3% compared to 2015, while the private sector was enlarged with 3 hospitals and 799 beds (7.7 % in­crease). Hospitalizations increased 1.8 times in 2015 compared to 2000 with a 74 times increase of the private hospitals only. This tendency continued in 2016 and private hospitals` admission as a share of total hospitalizations increased from 26.3 % in 2015 to 28.3 % in 2016. The average expenditure per hospitalized patient increased by 54.3 % in 2016 compared to 2003.Conclusion: Extensive development of the hospital care in Bulgaria in 2000-2016 is mainly due to pri­vate sector development. The total hospital expenditure increased mostly due to the increase of hos­pitalizations rather than to the increase of the expenditure per hospitalized patient.