In 2022, the Ministry of Health (MoH) took further steps to extend coverage of the NHIF benefits and obstetric care for uninsured women covered by the MoH. The MoH changed two ordinances expanding the prophylaxis benefit package and the package of obstetric care and medical diagnostics. Together, these ordinances aim to strengthen prophylaxis and care delivered to pregnant women at the primary and secondary care levels. Bulgaria has a higher maternal mortality ratio than the European Union average at 10 deaths per 100 000 live births versus 6 in 2017.
The first ordinance, amended in June 2022, regulates prophylactic check-ups and medical examinations and aims to improve the opportunities for early diagnosis among children, adults, and pregnant women, specifically. It expands the services in the prophylaxis benefit package to include diagnostic tests for children 7 to 18 years old; two additional ultrasound checks-up for pregnant women; an ultrasound examination of fetal morphology in addition to the biochemical screening; a hepatitis C test during pregnancy; and new diagnostic tests for people above 18 years of age.
The second ordinance – on the provision of obstetric care to uninsured women – strives to improve access to specialized outpatient and inpatient care for formally uninsured pregnant women by increasing the number of obstetric check-ups for pregnant uninsured women that is covered by the MoH's budget to four during pregnancy. The package has been further extended to include additional diagnostic tests. The ordinance was amended in August 2022 after broad public discussions and stakeholders’ advocacy involvement. The change will enter into force from 1 January 2023. Expanding the coverage of the obstetric services provided to those women outside the scope of mandatory health insurance has the potential to significantly improve maternal and newborn health outcomes.