Bulgaria to grant tax return to citizens for doing annual health checks

The Bulgarian government will offer financial incentives consistent with mandatory annual preventive health examinations, in a move that could be dubbed a “tax return” and is aimed at improving overall public health.

Tax authorities will return one annual health insurance contribution to the taxpayers, the last one for the year, to be precise, if they have been to the doctor for their annual examinations.

The measure aims to motivate Bulgarians, who usually shun preventive examinations, to get tested at least once a year, ultimately improving public health.

“The current team of the Ministry of Health sets prevention as its priority. The main incentive is the protection and care of our own health and that of our loved ones. We want to send this message to society. We will use various information campaigns dedicated to the importance of prevention,” the ministry told Euractiv Bulgaria.

Every health-insured person in Bulgaria has the right to a preventive examination once a year. It is carried out by general practitioners, who are obliged to display information about the type and frequency of preventive examinations and tests in a prominent place in their office.

The ministry has high expectations that the project will work. Preventive examinations, although free, are extremely unpopular among the population.

According to the official statistics for 2022, only 2,345,764 Bulgarians had mandatory preventive examinations with their personal doctor. This is only 41% of all health-insured persons over the age of 18.

Up to September of this year, only 22% of the health-insured citizens underwent mandatory examinations.

This means that more than half of Bulgarians did not take advantage of this opportunity.

GPs define this as a “worrying trend”, as prevention can help catch many diseases at an early stage, making treatment more accessible and cheaper.

Carrot and stick approach

A study by the sociological agency Trend on the attitudes of Bulgarians towards annual preventive examinations, conducted before September, shows that 11%, or about 600,000 Bulgarians, have never had a preventive examination at their GP.

Another 25% say they don’t have an annual check-up but get treatment when needed. These examinations are most unpopular among men and younger people, who are in good general health and think they do not need them, Trend’s results show.

These statistics forced the Ministry of Health to use the “carrot and stick” principle. Those who have had their annual preventive examination will save money on one health insurance premium. Conversely, fines are imposed on those who have not done so.

Penalties for not going for a preventive examination are complex to impose, however. General practitioners from the 26th Polyclinic in Sofia told Euractiv Bulgaria that they cannot imagine how the measure will work because it is not yet clear who will impose these fines on patients.

“Doctors do not impose fines anywhere in the world. We are doctors, not accountants. This is the work of the regional health inspectorates but they still do not have a mechanism for how to do this,” one of the doctors commented on condition of anonymity.

Another doctor said the worst option would be to make it mandatory for GPs to remind their patients when it is time for an appointment. They have a huge number of patients; they are also overwhelmed with bureaucracy and are more often “clerks than doctors”.

The idea of fines is not new; it is written in the Health Act. The law states that anyone who does not undergo mandatory preventive medical examination or immunisation would be punished with a fine of €25 to €50, and in case of repeated failure to appear – from €50 to €100.

According to the doctors of the 26th Polyclinic, these fines do not scare anyone and, as far as they could tell, no one has ever been fined for not showing up.

Electronic preventive calendar

The Bulgarian government is actively developing a project for an electronic preventive calendar by the Ministry of Health and the National Health Information System.

Through the calendar, people will be informed about the best time to contact their doctor and have a preventive examination. Everyone can benefit from the screening programs, regardless of their health status, because they will be paid for from the state budget.

The system will allow the patient to receive a message informing them when there is time for a preventive examination, when they had tests and what medicines they received.

The goal of the state is to reach the personal digital space of the citizens and, in this way, ensure that a larger number of people will receive information about the benefits of prevention.

Another goal is to change the attitude among many Bulgarians that only the sick should visit a doctor.

The new prophylactic and screening project is intended primarily for healthy people.

[By Antonia Kotseva, Krassen Nikolov – Edited by Vasiliki Angouridi/Zoran Radosavljevic | Euractiv.com]

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