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Country of the Month - Bulgaria

June 2014


Report prepared by Dr Evgeniy Goshev with the assistance and advise from:

Assoc. Prof. Ivan Tomov Gruev, Chairman of the working group on epidemiology, prevention and rehabilitation of CVD of the Bulgarian Society of Cardiology

National CVD Prevention Coordinator for Bulgaria:
Evgeniy Georgiev Goshev
Associate Assistant, Cardiologist
Medical Institute of Ministry of Interior
Clinic of Cardiology and Intensive Care, Sofia, Bulgaria
Contact: email

Health care | Risk factors | Prevention actors & activities | Cardiac Rehab. | Future

Documents to download

Health Care

In Bulgaria the health care system is financed via the National Health Insurance Fund, but there is a substantial private sector with only few group practices. The prevailing form of organisation of health care is individual practice. The overall availability of doctors in primary outpatient care in 2011 was 6.8 general practitioners per 10 000 inhabitants, and the average number of patients for 1 general practitioner is 1508.

In 2012, specialist outpatient medical care in the country has been provided by 4054 institutions, of which 3 050 individual practices of specialist doctors. The hospital sector in the country includes 312 medical care institutions, out of which 226 are public ownership and 92 are privately owned, which constitutes a mixed public-private system of hospital care.
In 2012, the hospitals had 45 726 beds at their disposal. The availability of hospital beds for the population in 2012 was 62.79 per 10 000 people.

In Bulgaria 4.1 % of the overall health expenditure are invested in public health care and prevention programs.

Risk factors

Bulgaria belongs to the high-risk countries of the EU, yet the indicator for premature mortality rate decreases. Premature mortality in Bulgaria in 2012 was 29.8% among men, compared to 14.2% among women.
In the year 2012, the rate of smokers among adults was 36%. The dietary habits remain unsatisfactory with a high consumption of fat and red meat, sweets and soft drinks.
A sedentary way of life is common for all age groups of the Bulgarian population. Arterial hypertension is prevalent in 42.8% of men and 39.7% of women in active age (between 24 and 65). Finally, diabetes mellitus affects 8.3% of the population.

Prevention actors & activities

There are institutions for preventive cardiology and rehabilitation centres at all five Bulgarian Universities. A National Health Care Strategy has been worked out for the period 2014-2020, in which the fight against Cardiovascular Diseases (CVD) takes a central place.

Cardiac Rehabilitation

In spite of great traditions for cardiovascular rehabilitation in Bulgaria, the service is poorly disseminated and severely under-financed. Merely 20 % of the patients with acute coronary syndromes are referred for cardiac rehabilitation. However, 75% of the patients after cardiac surgery are offered to participate in a rehabilitation programme.

Aims for the future

The main target for the future is educating patients and even the general population to restrict the increasing prevalence of arterial hypertension, promote physical activity and combat overweight especially among children and youngsters. It is planned to engage as many as possible governmental and non-governmental organisations in these activities.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology