| Verified against primary record | |
| Prior authorisation requests (2023) | 3 received, 0 authorised, 1 refused, as reported[1] |
|---|---|
| Reimbursement requests (2023) | 12 received, 7 granted, 5 refused[1] |
| Reporting caveats recorded | Figures do not add up; the authorisation time limit is not expressed in working days; data were supplied already converted to euro[1] |
| National contact point | National Health Insurance Fund[2] |
| Independently reported | |
| EU patients using the Directive each year | About 200,000, under 0.05 per cent of EU citizens[3] |
| Bands apply only to the rows beneath them. The authorisation figures are reproduced exactly as reported, including the inconsistency the Commission flags, and have not been adjusted to balance. All counts are claims by Bulgarian insured persons for care obtained abroad and are not a count of foreign patients treated in Bulgaria. With a total of twelve reimbursement claims, no percentage computed from these figures carries any weight. No typical cost range is given because no official Bulgarian source publishes prices paid by foreign patients. | |
Medical tourism in Bulgaria is, on the official European measure, close to non-existent in both directions of recorded claims. Bulgaria reported twelve requests for reimbursement of cross-border care in reference year 2023 and three requests for prior authorisation, and the European Commission notes that the Bulgarian authorisation figures do not add up as reported. No official Bulgarian count of foreign patients treated in Bulgaria was located for this article.
Twelve claims
For reference year 2023 Bulgaria recorded twelve requests for reimbursement of care not subject to prior authorisation, of which seven were granted and five refused. On the authorisation route it recorded three requests received, none authorised and one refused.[1]
Those authorisation figures are internally inconsistent, and the Commission identifies them as such: three requests received cannot be reconciled with none authorised and one refused. They are reproduced here exactly as reported rather than corrected, because the inconsistency is a property of the published record and adjusting it would misrepresent the source.[1]
Twelve reimbursement claims is among the smallest national totals in the collection, for a member state of roughly six and a half million people. Set against Slovenia’s 3,189 claims for a population of about two million, the contrast is not plausibly explained by patient behaviour alone, and the Commission offers no explanation for it.[1]
Two further reporting caveats
The Commission records that Bulgaria’s authorisation time limit is not expressed in working days, which means it cannot be placed directly alongside the working-day limits reported by other member states.[1]
It also records that Bulgaria supplied its data already converted to euro. The report otherwise converts financial figures at December 2024 reference rates, so a country that converts its own figures introduces an unknown and different exchange basis into the comparison.[1]
Taken together with the figures that do not balance, the Bulgarian entry is a compact illustration of why national returns in this collection cannot simply be placed side by side and ranked.
The framework
Bulgaria’s designated national contact point for cross-border healthcare is the National Health Insurance Fund.[2]
Under Directive 2011/24/EU the member state of affiliation must reimburse cross-border care where the treatment is among the benefits it covers domestically, capped at the level of costs it would have assumed and not exceeding the actual cost received. Prior authorisation may be required only for care subject to planning requirements involving an overnight hospital stay or highly specialised and cost-intensive infrastructure, for treatments carrying a particular risk, and for providers raising serious quality or safety concerns.[5]
Eurostat separately maintains a collection of hospital discharges of non-residents, with tables for in-patients, day cases, bed days and average length of stay, reporting country of residence where member states can supply it. Individual cell values for Bulgaria were not retrievable for this article.[4]
For scale, the European Court of Auditors estimated about 200,000 patients a year using the Directive across the Union, fewer than 0.05 per cent of EU citizens, and found that fewer than 20 per cent of citizens surveyed in 2015 were aware of their cross-border healthcare rights, a finding that bears directly on very low national claim counts.[3]
Limits of the evidence
Almost nothing can be said quantitatively about Bulgaria from these sources. The claim counts are too small to support any rate or trend, the authorisation figures do not balance, the time limit is measured on a different basis from other countries’ and the financial data were converted before submission. No official Bulgarian count of foreign patients treated in Bulgaria was located. Bulgaria’s privately funded dental and cosmetic sectors appear in none of these sources and no figure for them has been estimated.
See also
- Medical tourism statistics, and why these returns cannot simply be ranked
- Medical tourism and health literacy, relevant to very low claim counts
- Medical tourism in Slovenia, a smaller country with far more claims
- Dental tourism, a privately funded flow absent from these figures
- Cross-border healthcare, the framework producing the Bulgarian figures
References
- European Commission, Directorate-General for Health and Food Safety. Data on cross-border patient healthcare following Directive 2011/24/EU, reference year 2023. 15 May 2025. Verified against primary record: the report was opened and the Bulgarian rows for prior authorisation and reimbursement, the note that the Bulgarian figures do not add up as reported, the note that its authorisation time limit is not expressed in working days, the note that Bulgaria supplied data already converted to euro, the December 2024 conversion basis used elsewhere in the report, and the Slovenian comparator were read directly. Retrieved 23 October 2026.
- United Kingdom government publishing service. EEA countries and contact points. Verified against primary record: the list was opened and the designation of the National Health Insurance Fund as Bulgaria’s national contact point was read directly. The document does not state a publication date, which is recorded here as a limitation. Retrieved 23 October 2026.
- European Court of Auditors. Special Report 07/2019: EU actions for cross-border healthcare. 2019. Verified against primary record: the report was opened and the annual patient estimate, the share of citizens and the 2015 finding that fewer than 20 per cent of citizens surveyed were aware of their cross-border rights were read. Retrieved 23 October 2026.
- Eurostat. Hospital discharges and length of stay for inpatient and curative care (hlth_hosd), reference metadata. Last updated 15 December 2025. Verified against primary record: the metadata page was opened and the non-resident definition, the statement that country of residence is reported, and the list of non-resident tables were read. Retrieved 23 October 2026.
- European Parliament and Council. Directive 2011/24/EU, Chapter III, Articles 7 and 8. 9 March 2011. Verified against primary record: the chapter text was opened and the reimbursement rule in Article 7 and the three permitted grounds for prior authorisation in Article 8(2) were read. Retrieved 23 October 2026.
Sourcing note: this entry uses only official sources. The Bulgarian authorisation figures are reproduced exactly as published, including the inconsistency the Commission flags, rather than reconciled or silently dropped. No rate or trend has been computed from twelve claims. No official Bulgarian count of foreign patients treated in Bulgaria was located, and no figure has been estimated for privately funded treatment.