Patients’ Rights in Bulgaria

1. Patients’ Rights in Bulgaria February, 2009 Budapest, Hungary

2. The Current Situation: • 91% of people in Bulgaria have no idea which organization is responsible for defending their rights as patients • 94,7% of respondents never filed a complaint concerning problems with medical care • 37% have not heard of their right to informed consent in case of diagnostic or treatment (National Centre for the Study of Public Opinion, 2007)

3. Patients’ Rights Legislation: Patients’ rights in Bulgaria are arranged in 6 laws and 4 regulations: • The Health Act • The Health Insurance Act • The Medical-Treatment Facilities Act • The Medicinal Products in Human Medicine Act • The Professional Organizations of Doctors and Dentists’ Act • The Transplantations Act • The National Framework Contract • 3 regulations of the Health Minister

4. Achievements of Patients’ Rights Legislation in Bulgaria: Formally complied with all the latest practices in EU: • Right to free choice • Right of access to high quality health services • Right to be informed • Right to a second opinion • Respect for one’s self and dignity

5. Achievements of Patients’ Rights Legislation II: • Protection of personal data concerning one’s health status • Right to refuse treatment • Right to participate in the decision-making process in healthcare through representatives of patient organizations

6. Weak Points: • Lack of mechanisms for protection of these rights • Lack of specialized institutions responsible for the enforcement of patients’ rights • Lack of medical standards • Lack of a clear definition for a representative patient organization • Lack of a unified act concerning patients’ rights

7. Access to Patient’s Health Documentations: • Patient’s health data falls under the scope of the Protection of Personal Data Act. Access to medical documentations have: • The patient himself • The National Health Insurance Fund • Health documentations could be required by Commission from the Regional Healthcare Centre or the judicial authoritiesin certain cases

8. Treatment of Bulgarian Citizens abroad: • Health insured Bulgarian citizens can use emergency medical care in case of temporary stay in the EU member states, using the European Health Insurance Card (EHIC) • Planned treatment in another European country is possible only after prior authorization from the NHIF – or the Health Ministry when children are concerned (10 people in 2008) • In case of a prolonged stay in another member state, European forms are applied (E106, etc.) • Budget for treatment in the EU is voted annually by the National Assembly (BGN 20 million in 2009) • For treatment of Bulgarian citizens in countries outside the EU bilateral agreements could be in force • In any other circumstances the patient pays directly the providers of medical services

9. Treatment of Foreign Citizens in Bulgaria: • In case of temporary stay in Bulgaria, health insured citizens from EU member states receive medical care in health establishments which have agreements with the NHIF • European citizens must have an EHIC • They owe a consumer tax amounting to 1% of the minimum wage in Bulgaria for a medical examination in primary healthcare and 2% for each day of hospital treatment • European citizens staying in Bulgaria for a long period need a certificate for registration at the NHIF – E 106, E109, etc.