Healthcare costs in Bulgaria are rising at a significantly faster pace than overall inflation, with price growth in the sector in 2026 roughly twice the national average compared to 2025, according to an analysis of the country’s health insurance system presented at the Bulgarian News Agency. The report, prepared by Health Metrics, outlines a series of proposals aimed at strengthening the financial framework of the National Health Insurance Fund (NHIF) for the 2026–2027 period.
One of the key pressures identified is demographic. Health Metrics expert Ekaterina Illarionova pointed out that nearly half of Bulgaria’s workforce is over the age of 45, a threshold beyond which chronic illnesses become far more common. She also noted that the country is among the fastest-aging in the European Union, while preventable mortality remains among the highest. “The system is under pressure from an aging population, a limited revenue base and rising costs,” she said, adding that funding continues to shift toward hospital care rather than prevention.
The financial burden on households is also intensifying. According to healthcare macroeconomist Arkadi Sharkov, out-of-pocket payments in Bulgaria are more than twice the EU average, placing the country at the top of the bloc in this category. Over the past five years, household spending on healthcare has increased by around 60%. “Nearly 77% of these co-payments go toward medicines,” he explained, including drugs that are only partially covered by the NHIF.
Sharkov also highlighted structural issues in the pharmaceutical sector. Between 2022 and 2025, discounts provided by drug manufacturers to the NHIF rose by nearly 115%, but this has led some companies to reconsider whether to keep certain products on the Bulgarian market. Drug pricing in the country is strictly regulated and benchmarked against ten EU states, with the lowest available price applied domestically.
To address these imbalances, Health Metrics proposes increasing the health insurance contribution from 8% to 10%, ensuring full payments for groups insured by the state, and reducing the number of uninsured individuals, currently estimated at 11–12% of the population. Additional recommendations include directing excise revenues from harmful goods toward healthcare, guaranteeing annual growth of at least 10% in NHIF spending, and aligning drug budgets proportionally with overall health expenditure increases. The expected outcome, according to the analysis, is “greater financial stability, fewer hidden deficits and better protection for households.”
The report also warns of external risks. Sharkov said US-imposed tariffs on pharmaceuticals are already influencing prices in Europe and could have further impact. He cautioned that without coordinated policies, “Europe risks permanently falling behind in the global biotechnology race.” At the same time, disruptions in maritime traffic, particularly through the Strait of Hormuz, have already caused a dramatic drop in drug supplies in some markets, with shortages in the UK cited as an early signal of broader pressures across Europe.