7. Health insurance system. National Framework Agreement.
Explains how health insurance collects, manages and spends healthcare funds in Bulgaria, introduced in 2000 on a Bismarck-type model with contributions split between employee and employer. Covers the solidarity principles, the roles of the National Health Insurance Fund and its regional funds, and the NHIF dental packages for different age groups and needs. Also describes the National Framework Agreement between the NHIF and the dental and medical associations, the Beveridge-style National Health Service for comparison, and the system's advantages and problems.
Inside: 8 sections · 6 flashcards · 3 min
Topic 19 of 38 in the MU Sofia syllabus for Dental Public Health (Dental Medicine, Year 3). The free AceMed note covers it in 8 sections, about 367 words (3 min of reading), with 6 flashcards.
In this note
Healthcare Insurance
Health Insurance in Bulgaria
Principles of Compulsory Health Insurance
National Health Insurance Fund (NHIF)
NHIF Dental Packages
National Framework Agreement (NFA)
National Health Service (NHS)
Problems of the System
Healthcare Insurance
Health insurance = system for collecting, managing and spending financial resources for healthcare services.
Purpose:
Guarantees access to healthcare
Provides financial protection against healthcare costs Ensures solidarity between insured persons
In Bulgaria:
Introduced on 1 July 2000
Based mainly on the Bismarck model
Operates through compulsory health insurance
Health Insurance in Bulgaria
Managed by:
National Health Insurance Fund (NHIF)
Regional Health Insurance Funds (RHIF)
Main funding sources:
Health insurance contributions
State budget transfers
Direct patient payments
Voluntary/private health insurance
Health insurance contribution:
Total = 8% of income
3.2% paid by employee
4.8% paid by employer
State pays insurance for:
Children
Students
Pensioners
Unemployed persons
Socially vulnerable groups
Principles of Compulsory Health Insurance
Solidarity principle
Healthy support sick
Higher earners contribute more
Equal access
Insured citizens have equal rights to healthcare services Shared responsibility
State, employers and citizens participate in financing Public control of funds
NHIF expenditure is monitored and regulated
Free choice
Patients may choose their healthcare provider
National Health Insurance Fund (NHIF)
Central institution responsible for compulsory health insurance.
Main functions:
Collects health insurance contributions
Purchases healthcare services
Signs contracts with healthcare providers
Pays providers for services performed
Controls quality and expenditure
Guarantees the basic healthcare package
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