During the past decade, the reform in the Bulgarian health care sector was in the focus of policy and research discussions at national and international level. In spite of the great expectations after the introduction of social health insurance in 2000, efficiency, equity and quality problems in health care provision in Bulgaria continue to exist. The unequal start of the reform in outpatient and hospital care (namely the delay in restructuring the hospital sector) is one of the causes of these problems. Among other issues, the reform also included the implementation of formal patient charges. At present, formal patient charges are applied to all levels of medical services with the exception of emergency care. Nevertheless, informal patient payments continue to exist. The aim of this paper is to present the attitudes of health care stakeholders toward patient charges from the perspective of the state of the Bulgarian health care system. The data are collected via focus group discussions and in-depth interviews carried out in Bulgaria in May-June 2009. The results are used to out-line recommendations for policy related to patient payments

During the past decade, the reform in the Bulgarian health care sector was in the focus of policy and research discussions at national and international level. In spite of the great expectations after the introduction of social health insurance in 2000, efficiency, equity and quality problems in health care provision in Bulgaria continue to exist. The unequal start of the reform in outpatient and hospital care (namely the delay in restructuring the hospital sector) is one of the causes of these problems. Among other issues, the reform also included the implementation of formal patient charges. At present, formal patient charges are applied to all levels of medical services with the exception of emergency care. Nevertheless, informal patient payments continue to exist. The aim of this paper is to present the attitudes of health care stakeholders toward patient charges from the perspective of the state of the Bulgarian health care system. The data are collected via focus group discussions and in-depth interviews carried out in Bulgaria in May-June 2009. The results are used to out-line recommendations for policy related to patient payments