Foreign tourists in Bulgaria are still having problems accessing free medical services. This, despite the passing of an ordinance five years ago that stipulated the provision of such care to short-term visitors.

According to Vesselin Balkanski, head of the Regional Centre for Healthcare Services in Varna, European Union tourists who have paid contributions to their respective countries’ national health insurance funds face problems at Black Sea resorts because of a loophole in Bulgarian legislation.

Currently, if a foreign tourist visits a doctor in a seaside resort near Varna, he will pay for the medical exam and receive a receipt. Based on that receipt the foreigner’s respective national health insurance fund will be reimbursed by the Bulgarian National Health Insurance Fund (NHIF). For that, however, the NHIF must have a signed contract with the doctor who issued the receipt.

This is where the problem lies, according to Balkanski. "None of the doctors working in the resorts have a signed contract with the NHIF," he told The Sofia Echo on April 27. "Hence the foreigner’s health insurance fund cannot retrieve its money from the Bulgarian one because the latter has no legal relationship with the doctors working in resorts."

Resort doctors prefer to work directly with private insurance companies, not national health organisations. That way they can charge foreigners similar rates to those of their home countries, which is several times higher than what Bulgarians pay. This works when foreign tourists have medical insurance from a private company but if the foreigner comes to Bulgaria without one, his national health body is left empty-handed. That being said, foreigners are not being refused treatment, albeit at a steep price and in contravention of the ordinance.  

"According to conventions signed by Bulgaria, all EU nationals can have medical assistance based on  health insurances they have paid in their home countries," Balkanski said. "This, however, is not happening in Bulgaria."  

He also said that doctors in Bulgaria are not obliged to have contracts with the NHIF. Hence there is no cap on the rates they set. "If doctors had contracts with the NHIF they would have to limit their charge to 12 leva for a first medical check. Currently, they charge between 40 and 50 euro. I have heard of prices of 200 euro and even more for certain medical interventions," he said.  

Currently, doctors are merely obliged to display their tariffs in a conspicuous place. Balkanski said that Bulgarians also suffer from this practice-so the issue is not necessarily one of dual pricing-but to a lesser extent. "Bulgarians can go to the nearest town and village and find a doctor who has a contract with the NRIF. Otherwise, they will be charged the same rate as foreigners."

For a foreigner entering Bulgaria for a week, however, this is hardly an option particularly since he would discover the problem only when his national health body received the receipt.

The situation could be rectified if all doctors signed contracts with the NHIF. Balkanski suggested this to the Health Ministry 18 months ago but doctors working in resorts were unenthusiastic. The reason is, of course, financial. "In most cases, doctors use hotel premises in resorts. They pay high rents, somewhere between 15 000 and 20 000 leva a season.

So they need to charge high rates to pay their rent." Balkanski has raised the issue with hotel owners, suggesting that they lower rents so that doctors are not pressed against the wall, but so far there hasn’t been a response. "After all, hotel owners have an interest in providing the best medical service possible to their clients."