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Healthcare Resource Guide: Bulgaria

Bulgaria Statistics

Summary

Market Entry

Current Market Trends

Main Competitors

Current Demand

Registration Process

Barriers

Trade Events

Best Prospects

CS Contacts

Capital: Sofia

Population: 7 million

GDP*: USD 48.95 Billion

Currency: BG Lev

Language: Bulgarian

Summary

Bulgaria’s 2016 healthcare budget is estimated at 4.2 percent of GDP or USD 1.98 billion, considerably lower than the healthcare budgets of major Western European countries.

Table 1: History of Healthcare Expenditure as Percentage of GDP

Source: Bulgarian Industrial Association (www.bia-bg.com)

Bulgaria’s healthcare system is funded through a compulsory health insurance system called the National Health Insurance Fund (NHIF). The country’s healthcare budget has steadily increasing over the years as the contribution by patients/citizens to the system has decreased. As this trend continues the Government will need to take measures to transform the sector and implement a national health strategy 2014-2020 to increase efficiencies (NHIS; see Table 1).

Yearly, the NHIF treats some 2.33 million insured Bulgarians in 349 hospitals of which:

  • 103 are private hospitals
  • 176 are general hospitals, and
  • 147 are specialized hospitals

Additionally, there are:

  • 1,931 out-of-hospital care facilities
  • 117 diagnostic centers
  • 617 medical centers, and
  • 1,103 laboratories, and others. (Source: National Statistics Institute)

Numerous U.S. and international entities have opened clinics hospitals and medical centers; two large private hospitals have their Joint Commission International accreditation; and, medical tourism is becoming popular as Bulgaria is increasingly a desirable tourist destination

Table 2: Bulgaria’s National Healthcare Insurance System 2012-2016: NHIF’s Disparities in Collection and Spending (in thousands of USD)

 

2012

2013

2014

2015

2016 f

Total Income

2, 225

2, 245

2, 301

2, 393

2, 489

Total Expenses

2, 621

2, 653

2, 758

2, 867

2, 981

Note: Publically available data in Bulgaria is scarce and unreliable. These figures have been estimated using available information and industry contacts.

Chart 1: Hospital Care Costs in Bulgaria 2008-2013

H:\DesktopFiles\Milko Minev\Desktop\hospital care increase.jpg

Source: Bulgarian Industrial Association (www.bia-bg.com); 1 USD = 1.75 BGN

Key Opportunities

Bulgaria’s health sector reform strategy encourages modernization and upgrades in a wide range of areas to include:

  • Demand for invasive and noninvasive surgery equipment, ultrasound equipment, in-vitro diagnostic equipment, urology equipment, laboratory and testing equipment, diagnostic imaging equipment, equipment for haemodialis, tissue and blood bank related equipment, veterinary turnkey project equipment, hospital care equipment, information systems, modern patient monitoring systems, hospital management systems, new high tech products such as laser instruments, magnetic resonance picture imaging apparatus and computerized systems for cosmetic, aesthetic and restorative medicine including such for dentistry
  • Demand for X-ray systems, dental mechanical tools and instruments, dental surgery services, surgical tools, chairs, ultrasound equipment, photopolymer equipment, physiotherapy equipment, abrasive tools, maxillary surgery, anesthetics, sterilizing equipment, fittings, appliances, metal workplaces, ceramic work places and plastic workplaces, and
  • Demand for telemedicine and introduction of healthcare portal to be based on unified healthcare database files for every Bulgarian citizen fully compatible with EU standards

Market Entry

There are no specific challenges to the business environment which could be considered a serious threat. The institutions regulating and monitoring market entry rules are Ministry of Healthcare (www.mh.government.bg), National health Insurance Fund (www.nhif.bg), National Veterinary Institute (www.vetinst.bg) and the Bulgarian Food Safety Agency (www.babh.government.bg).

Current Market Trends

Bulgaria becomes an interesting destination for foreign medical groups who are looking to expand in the market. The largest deal in the medical sector happened in May 2016 when Acibadem (Turkish holding company) bought the largest private hospital in the country and 30% of the one of the best private hospitals. Following the acquision the new hospital has a capacity of 1 000 beds.

Main Competitors

All major European medical equipment, medical devices, laboratory and veterinary companies are active on the local market and for over 20 years. To name a few: Siemens, Philips, Toshiba, Draeger Medical; Atom medical; Bovie Aaron; Nipro Corp; Olympus and many more.

Current Demand

  • Demand for invasive and noninvasive surgery equipment, ultrasound equipment, in-vitro diagnostic equipment, urology equipment, laboratory and testing equipment, diagnostic imaging equipment, equipment for haemodialis, tissue and blood bank related equipment, veterinary turnkey project equipment, hospital care equipment, information systems, modern patient monitoring systems, hospital management systems, new high tech products such as laser instruments, magnetic resonance picture imaging apparatus and computerized systems for cosmetic, aesthetic and restorative medicine including such for dentistry
  • Demand for X-ray systems, dental mechanical tools and instruments, dental surgery services, surgical tools, chairs, ultrasound equipment, photopolymer equipment, physiotherapy equipment, abrasive tools, maxillary surgery, anesthetics, sterilizing equipment, fittings, appliances, metal workplaces, ceramic work places and plastic workplaces, and
  • Demand for telemedicine and introduction of healthcare portal to be based on unified healthcare database files for every Bulgarian citizen fully compatible with EU standards

Registration Process

Mandatory required certifications are the CE mark as well as some ISO standards such as ISO 9001, ISO 13485 and ISO 13795.

Few of the medical device directives are aligned to those of the EU, namely:

  • Directive 90/385/EEC for implantable medical devices
  • Directive 93/42/EEC for medical devices in general and
  • Directive 98/79/EEC for in vitro medical devices

Barriers

There are no significant barriers to trade on healthcare related products in Bulgaria. Some tariff and non-tariff barriers are reported in the pharmaceutical market sub-sector by the LAWG and might be viewed in the National Trade Estimate Report when existing.

Trade Events

Bulmedica/Buldental

May 2015, May 2016

www.bulgarreklama.bg

Medicus

June 2015, June 2016

www.fair.bg

Best Prospects

Sub-sector best prospects include:

§ clinical research and monitoring

§ laboratory equipment (there are 800 laboratories in the country with annual revenue of USD 70 million)

§ hospital equipment

§ homecare equipment

§ emergency equipment

§ telemedicine and eHealth systems, and

§ mobile veterinary equipment and real-time PCR veterinary tests for the detection and eradication of pandemic diseases

U.S. Commercial Service Contact Information

Name: Milko Minev

Position: Commercial Assistant/Outreach Coordinator

Email: Milko.Minev@trade.gov

Phone: + 359 2 937 5145


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