The country is made up of 28 Regional Health Centres and 262 municipalities, and these hold a substantial responsibility for health care. The health care system was still mainly funded through taxation in the early 1990s, but a Health Insurance Act was passed in 1998, making provision for a National Health Insurance Fund and compulsory payroll tax.
One person working in palliative care in Bulgaria has set out the problems as follows:
'… no laws concerning palliative care and hospices, no association, no contracts with the national health services, no funds to operate, no credit available'.
From this perspective the major underlying problems are seen as structural in character:
'… economic collapse, the laws serve political interests and the three powers (the executive, the legislature and the judiciary) are not [equally] divided, low demand for everything, except food'.16
For this respondent building a stronger legal system, getting into the EU and obtaining a higher standard of living were essential prerequisites for palliative care development in Bulgaria.
Health care expenditure (US$) per capita, Central and Eastern Europe
Source: WHO Regional Office for European Health for All database and HiTs
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