Healthcare resilience and multidimensional challenges

Demographic development, growing impact of non communicable diseases (NCD), and increasing rate of healthcare costs present significant burdens to the healthcare systems in the European Union (EU). Similarly, the rising demand of healthcare services for older people, NCDs requiring long-term treatment and management, escalating healthcare costs due to various factors (including advanced medical technologies, higher demand for services, and the increasing prevalence of chronic conditions) pose significant pressure on the healthcare sector sustainability and efficiency. 

Bulgaria is no exception, where all these factors influence the country’s healthcare system and affect its resilience.

Key challenges that the Bulgarian healthcare system needs to address include the insufficient focus on preventive care, the lack of a unified system to collect health data, as well as the lack of adequate regulatory framework securing the correct conduction of the treatment-diagnostic process. By integrating prediction, prevention and early diagnosis of diseases into the core healthcare model, developing and utilizing a digital health infrastructure, as well as enforcing a comprehensive set of regulations and standards for healthcare practices, the healthcare system can move towards a more proactive and data-driven approach that will strengthen its resilience.

Preventive care 

The healthcare system is predominantly focused on treating diseases rather than preventing them. Prediction, prevention, and early diagnosis of diseases are often not prioritized and side-lined. Health prevention took up to 3 % of total health spending in Bulgaria (OECD Health Statistics, 2021).

The need to strengthen the role of the preventive care in the healthcare system is reflected in the Bulgarian National Health Strategy 2030 (adopted by the National Assembly, m. April 2024). Measures to implement the strategic priorities include: 

• An effective management of chronic non-communicable disease prevention activities; 
• A reorientation of the structures of the national health system towards prevention and early diagnosis of major chronic diseases; 
• Using a science-based approach to develop models for chronic NCD prevention. 

Strengthening the institutional and human capacity of the health promotion and disease prevention structures and expanding the range of services offered by health facilities to include health promotion and disease prevention, are also foreseen in the Health Strategy 2030.

еHealth and Digitalization 

Building an environment that provides a workable and reliable process for collecting and sharing health data in clinical practice and for research purposes is key to improve the healthcare quality and facilitate research. One of the guidelines aimed at effective data analysis and sharing is to unify and harmonise the process and format of data collection. With the adoption of the National Strategy for eHealth and Digitalisation of the Health System 2030 (adopted by the Council of Ministers, March 2024), Bulgaria declared its commitment to transform and modernise its healthcare. The strategy envisages the use of new technologies and innovative solutions to increase the efficiency and sustainability of the health system while ensuring better access to health care for all citizens. 

Regulatory Framework 

In today's rapidly evolving healthcare landscape, an up-to-date regulatory framework is essential for addressing emerging challenges such as technological advancements, demographic shifts, and global challenges. It provides a foundation for adapting to changing healthcare needs, ensuring that patient safety, quality of care, and public health remain paramount. The various strategic documents in the field of healthcare, recently adopted in Bulgaria, foresee the updating of the regulatory framework to align with the actions proposed in these strategies. 

How to tackle the challenges facing the health system 

Addressing these challenges requires numerous interventions across a vast health system. It is therefore important that the timing and implementation of actions should be consistent with their priority and readiness for implementation. The development of a digital health infrastructure, greater emphasis on improvements in preventive care, and alignment of the regulatory framework with current and future healthcare system needs are crucial. 

Implementing measures across various domains of healthcare management necessitates a holistic approach involving integration among different specialists and task forces. Collaboration between different stakeholders as healthcare providers, pharmaceutical and diagnostic companies, IT experts, policymakers, researchers and academics is essential to ensure cohesive and comprehensive solutions. It is, moreover, important to recognise that addressing healthcare system challenges involves transforming the healthcare environment. Thus, efforts must be aligned with other goals, such as improving public health, enhancing patient care, and promoting health equity. Recently, Bulgaria developed specific strategies to address these challenges - National Health Strategy 2030 (adopted in April 2024) and National Strategy for Electronic Healthcare and Digitisation of Health System 2030 (adopted in March, 2024). Their implementation is envisaging various endeavours across multiple strategic lines of action. 

By focusing on key areas as preventive care; eHealth and healthcare digitalization; adequate regulatory framework and regulations, Bulgaria can strengthen the resilience and effectiveness of its healthcare system, ensuring better health outcomes for its population and fostering a more sustainable healthcare environment. 

BAPEMED lab's methodological approach is based on exploring future scenarios to identify resilient policies that can work as relevant responses. By generating diverse scenarios, the lab will analyse the trends and factors contributing to the challenges within the healthcare system. It will then utilise factor projections and conduct policy testing against these scenarios to craft effective policies suited to various contexts. The BAPEMED lab places significant emphasis on participative foresight, engaging stakeholders, and building on existing networks established by the BAPEMED association.