The Bulgarian government's decision to allocate a record €4.8 billion budget for the National Health Insurance Fund (NHIF) in 2025 has sparked widespread criticism. Despite this substantial increase of 16.5% over the previous year, experts argue that without structural reforms, the additional funds will merely perpetuate an inefficient healthcare system. Former health minister Stoycho Katsarov highlights that while spending is rising, the quality of care remains stagnant due to misallocation of resources and an outdated hospital network. Critics emphasize the need for investment in preventive care and community-based services rather than expanding existing hospitals, which already suffer from low occupancy rates and a shortage of medical staff.

Despite the significant financial boost, Bulgaria's healthcare system continues to face challenges rooted in inefficiency. The country maintains one of the highest numbers of hospital beds per capita in the European Union, second only to Germany. However, this comes at a cost: many of these facilities operate well below capacity, with an average occupancy rate of just 53%. This paradoxical situation arises from a combination of factors, including a critical shortage of nurses and inadequate attention to preventive and pre-hospital care. Each year, hospitals expand their capacity by adding new clinics and wards, further straining the already stretched medical workforce. Meanwhile, private hospitals are also proliferating, leading to fragmented and often subpar healthcare services.

The growing reliance on private pharmaceutical companies to subsidize the healthcare system through discounts on drug therapies underscores the lack of sustainable funding. This dependency could pose risks, especially following the Constitutional Court's decision to abolish limits on hospital medication costs. This move has left the NHIF without effective mechanisms to control expenditures, potentially jeopardizing the budget. Former Health Minister Katsarov warns that this could lead to significant financial strain, particularly as Bulgaria aims to join the eurozone by January 1, 2026. Meeting the Maastricht criteria, including keeping the budget deficit below 3%, may become increasingly challenging.

Within the NHIF itself, opinions diverge sharply regarding the efficacy of the proposed budget. While NHIF manager Stanimir Mihaylov maintains that the budget is balanced and prudent, his deputy Nikolai Boltadzhiev voices strong opposition. Boltadzhiev argues that the budget fails to address fundamental issues, such as the disproportionate allocation of funds to hospitals. He contends that the increased budget should have been accompanied by more comprehensive reforms to improve both the quality and affordability of healthcare services. As debates continue, it remains clear that meaningful change in Bulgaria's healthcare system requires not just financial investment but also strategic reform.

As the debate over the NHIF budget intensifies, it is evident that the Bulgarian government faces a pivotal moment in shaping its healthcare future. The current trajectory, characterized by escalating costs and insufficient reforms, raises concerns about sustainability. To achieve lasting improvements, policymakers must prioritize long-term strategies that enhance efficiency, redistribute resources effectively, and invest in preventive care. Without such measures, the increased funding may fail to translate into tangible benefits for patients, leaving the system vulnerable to further challenges ahead.