Anyone in or near Batak?

Seems like he's only coming for a visit - can't he just bring whatever meds he needs with him?

He MAY be able to buy what he needs in a pharmacy: some are less strict than others when it comes to having a prescription, and some meds aren't available here anyway.

Batak's a nice town to visit but I don't know what it's like to actually live there - I scouted it out when I first came to BG 20+ years ago, but I eventually decided that it was too far from Sofia and its advantage of having medical etc facilities close to hand..

@JimJ

Thanks, he's coming initially to visit with ideas of eventually living there. He can get medication for 3 months however if he applies for residency he will need more meds.

@RachelG1980

Well if your dad does move over, then he will have to register with a doctor anyway, he could have a check over if he will need on going medication, quite straightforward and nothing to worry about.

He could ask at the pharmacy when he visits, some things that are prescription in the UK are over the counter in Bg, and some things over the counter here should need a prescription there, though it seems that often pharmacists can also prescribe or dispense some things. He may find he needs to pay for medication, even if he gets it free in the UK. And there may be some things that just aren't available in Bulgaria, which a pharmacist would be able to advise. We've found most pharmacies even in smaller towns have at least one staff member who speaks some English, though if your Dad doesn't speak Bulgarian it would probably help him to have someone who speaks both Bulgarian and English with him.

With a GHIC card, he can access public health care in Bulgaria as a visitor the same as a Bulgarian could. Many things like visiting the GP have a small fee, so I expect medication might as well. And if he decides to move as a retiree and gets his OAP in the UK, he can apply in the UK for an S1 form, which will let him register with the Bulgarian health system and then sign up with a GP.  If he's still working age it's a different process.

Many things like visiting the GP have a small fee, so I expect medication might as well. - @janemulberry

No "might" I'm afraid - and medication doesn't attract a "small fee", you pay full whack for it even as a pensioner.  There's a scheme which offers pensioners (Bulgarian only, despite what the gov.uk website might tell you about the S1) a reduction on the cost of prescribed drugs; my in-laws, on the usual pitiful BG pensions, are eligible for this.  My mother-in-law, who's diabetic and suffers from a couple more complaints, takes a cocktail of drugs prescribed by her GP - we calculated that her discount comes to a princely ONE LEV per month!

Ouch!

SWMBO was just visiting a relation who's been enjoying the delights of the BG health service. He's definitely ill and apparently has cancer but the various doctors he's been to see so far can't decide just WHERE the cancer(s?) is/are or what stage(s) it/they is/are at.

He's just had a kidney biopsy at Tokuda; it cost 7,000 leva!! The BG health service paid 5,000 of that and he had to fork out the extra 2 grand...

Don't assume that health care here costs peanuts - or that your S1 means you don't have to put your hand in your pocket for anything.

Can you pay for private health insurance and if so is it like BUPA where it increases with your health and age conditions or like the French where it’s just a general price.

@JimJ

So sad. Praying for him.

And after listening to your wisdom in this topic, hubby and I are unanimous about keeping a separate significant savings pot that can't be used for anything apart from healthcare. Hoping we won't need it!

Presumably the person chose to go to a private hospital rather than stay in the public system? It's understandable, if they weren't getting any nearer a diagnosis in the state system.

@JimJ

i follow a YouTube channel and they have lived in Bulgaria for many years but hadn’t been aware of costs until he needed a hip replacement and although his hospital costs were covered, the parts weren’t and the hip was very expensive and they were trying to find a cheaper one.

@janemulberry

I'm pasting part of a Facebook discussion I've been having regarding the topic of medical care here compared to elsewhere in Europe, just to clarify the situation as I've seen and experienced it. For context, the (Bulgarian) person I'm responding to had mentioned the "appalling" waits in Canadian A&E departments, which can exceed 4 hours (because urgent cases "jump the queue"). Obviously, the same is true elsewhere due to A&E departments being treated as an alternative to GP surgeries, alcohol and drug treatment centres etc. Sorry that, as usual, it's something of a screed...

"Yes, things are bad in A&E departments in many countries. My mother died, due to a large extent to the incompetence of an NHS Consultant and the frankly abysmal level of nursing care in a major UK hospital; and this was some 20 years ago. My perception was, and is, that the nurses were more interested in chatting about their career paths and how they were "educated professionals" and too important for mere nursing duties. The doctor responsible was too senior, and arrogant, to listen to any junior doctor - or even a physiotherapist who raised issues concerning a very poorly done operation which caused more harm than good.

After many decades living in several countries I've had more than enough personal experience of poor standards of medical treatment - and some very good ones - to tell good from bad.

I really like Bulgaria and fully intend to spend the rest of my days here; I've lived here over 20 years so far. However, while there are undoubtedly some very good aspects to medical care here, there are also MANY aspects in which it's as poor as, or even worse than, some third-world countries. Many of the older doctors I've encountered - some of them Professors - are well past their sell-by dates, and frankly I doubt that some were ever even competent in their prime. The younger generation of Professors contain some prime examples of people with no concept of bedside manners, who are arrogant and suffer from delusions of grandeur. Some have been fine, others not. I don't claim to know anything even approaching a statistically significant sample of Bulgarian doctors but I have had experience of the standard of medical care in several parts of the country, so I'm not talking about one or two "bad apples".

My father-in-law spent some time in what the Tokuda laughingly calls "Intensive Care"; he was sedated and incontinent. My wife and I paid thousands for him to be treated in "one of the best hospitals in the country", which seems to have gone downhill since it was acquired by its Turkish owners. We also had to provide the "Pampers" for him. That's no big deal. However what was shocking to me and my Bulgarian wife (not that it's relevant but she herself is a university Professor) is that WE had to be there every day to change his Pampers and bed linen, and clean him up! Such work wasn't in the nurses' job description and the hospital "couldn't find anyone to do this work despite offering huge wages". Frankly, in a modern European country that state of affairs is totally unacceptable!

Both my father-in-law and wife have had cancer, so we've perforce had a lot of experience with the Roma Blood Mafia. I imagine that it's even more expensive now but I can tell you that a year ago a unit of "donated" blood cost 250 leva and major operations need a LOT of blood to be available. It's the 21st century, FFS!! How is this kind of thing even conceivable, let alone "normal"?

I could give you many more examples of just how dire the medical treatment here can be but I'm even depressing myself. Let me just say that yes, in plenty of other countries getting good medical care is something of a lottery - but here it's more like Russian Roulette, and you even have to be sure to wipe the butt of the pistol in case you catch something! 😂 "

@JimJ

A kidney biopsy is a serious, expensive procedure. 7k lv sounds a little pricey, but not ridiculous, and Tokuda is the place I pick when I want to see a specialist up in the big city. On the other hand, 1k euros (after NHIF contribution, courtesy of your S1 or your NHIF monthly contributions) to get this done at a good, private hospital, pretty much when you want it, is a GREAT deal. I very much doubt you could match this elsewhere in the UK or EU. If money's tight, then you'd go to a public hospital, where you'd expect the 5k to cover it all.

Sure, it sounds like a lot. But it's a patient choice for fast, private service. In the UK, the NHS would give me a kidney biopsy for free, IF my GP and then the referred specialist were convinced that I needed one. If I wanted the Tokuda equivalent at my local private hospital, I'd have to pay the private cost (a lot. of course) in full. You have to compare like for like, not compare private with public and then complain it's expensive! :-)

Moreover, we don't know exactly where he is on his medical journey and how he decided on a renal biopsy. To me, I'm VERY surprised that folks know he has cancer, but don't know where or how bad. That seems extraordinary. There are a bunch of less invasive options (blood tests, ultrasound, CT scan, MRI, and various =scopies) that I'm pretty sure the NHS would run through before they jumped to a renal biopsy. But, no matter... he wanted it, and he got it... at an unbeatable price. Hopefully his treatment will be equally as good, and equally as affordable.

As to your other more general comments, I definitely agree that there are plenty of medical professionals who are rude, old, and perhaps not current with latest practice. I personally prefer to shop around and find younger options with great feedback on Superdoc. In terms of quality of care, I don't have personal experience of operations here. I am overdue for several operations (according to the surgeons), but I'm scared (whether it's Bulgaria or UK) of surgery and hospitals (as they're full of sick people). :-) So I am putting them off for as long as I possibly can (many years, so far) and trying as much conservative treatment as I can. I have friends who have had both public operations (in VT city) and private operations (in Medline, Plovdiv) and they are alive, and very happy with the standard of medical care. My GP is great (far better than my UK one), my dentist is great (also far better than my UK one), and I've found several specialists who have been very easy and pleasant and knowledgeable. When I've seen specialist surgeons in Tokuda, I came away very impressed... and the prices they quoted were outstandingly good.

Overall, I'm very happy with what I've seen of the Bulgaria health system. I'm not sure it's better than the NHS, but it does not seem significantly worse. The cost of my contributions (40 lv per month) is very low, far lower than elsewhere in the EU. (Of course, cheap is no good is they kill you on the operating table.) The Bulgarian option to go to private hospitals and pay a surcharge (rather than full price) strikes me as a luxury option that I have not seen offered elsewhere in the EU. Again, perhaps a Bulgarian private hospital (like Tokuda) is not as good as a BUPA hospital in the UK, but I'm quietly confident that it's far better than a Bulgarian public hospital. :-)

I'm fortunately (touch wood) very healthy, but the Bulgarian health cover is still one of the big reasons that I spend most of my time in Bulgaria rather than Cyprus or Spain (where I'm also a legal resident). It doesn't strike me as a better option to pay more per month in Cyprus or Spain, in order to be in their public systems instead. Especially as I can get a Bulgarian EHIC that covers me in both Cyprus and Spain, if I should NEED immediate treatment. Spain's system is pretty good, it's probably better than Bulgaria's. But I'd rather have private treatment in Bulgaria, than public treatment in Spain. Similarly, I do have concerns about letting Tokuda hack me open... but then letting a private hospital in the UK do it instead would cost many thousands. (e.g. 15k UKP for a private hip replacement, vs 10k in a cheap Turkey/Baltic specialist vs free in BG public hospital vs 1k euros in Tokuda).

Like you, I've lived here for a few years, and I'm guessing I'll die here (hopefully not on Tokuda's operating table). Bulgaria is far from perfect, and I can always find stuff to gripe about. But I'm not a poor Bulgarian on an insultingly low Bulgarian pension, so I'm insulated from most problems. Overall, I feel that Bulgaria has given me a chance to live a very nice life, and a very restful retirement. Indeed, the quality of life I have here is FAR beyond anything I could afford elsewhere in the EU. I hang out most Sundays at our local produce market with my teaching buddy (Bulgarian, but after 20 years in the UK). We sip our afternoon teas (1 euro for 2) and it's true that we grizzle like two old geezers... but we both agree that we have a really great life here, and we'd never want to go back to the UK. What more could we ask for? :-)

Can you pay for private health insurance and if so is it like BUPA where it increases with your health and age conditions or like the French where it’s just a general price. - @jeanmandredeix

Yup, true health insurance always gets more expensive based on age and preexisting conditions. And often has deductibles and exclusions (and sometimes age limits). This applies to the Bulgarian options too. (Separately, many get confused by the Bulgarian Health Insurance for Foreigners policy which they buy to keep immigration happy. This is very cheap, but it isn't a proper health insurance!)

Like everywhere, your options are to have have public coverage (like NHS), or a private health insurance policy (like BUPA), or pay out-of-pocket as needs arise. The public coverage here is very affordable (and free with an S1). I pay 20 euros per month as unemployed. The advantage of public coverage (such as the NHS or NHIF) is that you get free (or nearly free) treatment, and there are no deductibles, exclusions, or age limits. (And you can get an EHIC to use elsewhere in the EU.)

Like most/all the EU, Bulgaria has restrictions on economically inactive (pensioners, unemployed, rich but lazy) TCNs getting into the system. You either have to wait patiently for 5 years until you're a PR, or you have to get off the couch and go work (as employed or self-employed) for a few months. (Or wait until you retire and get an S1.)

Additionally, in Bulgaria you can choose to go to a private clinic or hospital as many (most?) are affiliated with NHIF and get reimbursed by it. (You have to check first, otherwise they can hit you with a big bill.) Which means you can get private treatment, immediately you want it, at a very small private surcharge. (Some folks think the surcharge is not small, but you need to compare the surcharge with the FULL cost of this private treatment either here in Bulgaria, or elsewhere such as UK, Turkey, etc.).

Because of this public/private cooperation, private insurers will have to pay less if you have public cover. And will therefore quote you less for your private health insurance policy. As the surcharges mentioned to me have been very low, I don't worry about having a policy. (But I'm very careful to make sure I keep up the payments and the NHIF coverage for me and my partner.)

@JimJ
i follow a YouTube channel and they have lived in Bulgaria for many years but hadn’t been aware of costs until he needed a hip replacement and although his hospital costs were covered, the parts weren’t and the hip was very expensive and they were trying to find a cheaper one. - @jeanmandredeix

I've had experience of expats who'd lived in other countries for many years but still had no idea of what REAL life was actually like there; most of them were Brits, so I wouldn't necessarily want to extrapolate that experience to other nationalities but it wouldn't surprise me if they were the same.

In rural France it was common to meet people who were lifelong social security claimants in Dover but Master Builders by the time the ferry docked in Calais; you'd meet them in the local bar (long before the Internet Age) pontificating about what "the French" thought and did, even though ordering their first beer of the night was a linguistic struggle to rival that of Laocoön with the serpents.

My neighbours in Corfu were real old-school Expats and had lived there since the 50s. They too had a great store of mostly-imaginary knowledge about "what and how the Greeks think" and what life was like for the local people. They were delighted when I bought the house next door to them (they'd never met a Greek who spoke English like Alvar Liddel 😎) and from Day One established a firm routine whereby I would present myself at their home every evening at 5:45 sharp. Any time "sharp"big course involves a monumental effort for a Greek, but the reason soon became clear:  6 o'clock in the evening was TV News time and my neighbours, despite nearly half a century in-country, could only understand about 10%, if that, of what was being said...

So I'm always rather sceptical of "old hands" handing out advice about "what the locals think and how they do things" when they often can't even speak the darned language. And of course, "how Bulgarians do things" often involves a "master" whose sole qualification is having seen his grandfather bodging the same job 30 years ago...I can show you plenty of examples of how that pans out! 😥

@gwynj

It's not really a question of "a patient choice for fast, private service" - he's depressed and disillusioned after so many conflicting "diagnoses", and it IS a lot for him as an average Bulgarian pensioner.  He's also concerned that a couple of the doctors gave him conflicting advice along the lines of "Don't use X Laboratories for your tests - they're not trustworthy!"  It would have helped if they'd at least warned him off the same labs... 😀

I recently consulted a urologist who is now a Professor; he was previously at Tokuda and operated on me some years ago for kidney stones.  He quite fancied himself in those days and he was obviously skiving the day they covered Bedside Manner at Med School, but now he's pretty much insufferable: I took the results of a very recent MRI, but he wasn't at all interested in those - he was insistent that I should fork out 1,700 euros for a new one, purely coincidentally at the hospital where he now works - and charged me 200 leva for the 2-minute "consultation".  I told him that I'd make an appointment for it, but I imagine that he's given up waiting for me to do so by now....🙄  Fortunately, there are other fish in the sea.

@JimJ

I'm so sad that your FiL is dealing with this. It does happen that people are known to have cancer -- hot spots all over on the PET scan, but which site is the primary can't be determined, meaning treatment is a challenge. I completely understand him choosing to go private to try to get a definitive answer and start treatment.

Getting decent healthcare is a concern, but after multiple bad experiences with doctors and hospitals in the UK, I'm not convinced we'll be worse off in Bulgaria.  We will surely make sure we have a significant fund set aside (what we'll get for the sale of our UK house) we can use for healthcare if needed.

Hubby had a similar experience to yours with the MRI -- three years of being shuffled between various cardiology professors at  the major London teaching hospitals. None of them actually addressed what the GP referred him for, a blockage in the heart's electrical system, because the first professor misdiagnosed him as hypertensive on the basis of a single high reading on a faulty machine. Not done at all in accordance with the British Hypertension Society guidelines, but these guys think guidelines only apply to the little people not to them! And none of the other professors dared contradict the first great man. They did all, however, want to repeat the big expensive stressful tests, because "we don't trust their tests". Not one would answer even his most basic questions, and the medication they recommended is contraindicated in someone with his underlying condition! Quite rightly, his GP refused to prescribe it. Thankfully there was no financial cost, but the cost in stress, frustration, and fruitless trips to London was huge. He discharged himself in the end because it was going nowhere.

A year later, the original problem he was referred for reached the inevitable conclusion -- a life threatening slow heartbeat when his heart's electrical system completely packed in. Thank God, our previously failing local hospital has improved since our last bad experience there years ago for a different issue, and he got to see an excellent interventional cardiologist who immediately booked him for a pacemaker. The treatment the professors should have advised but didn't, because their heads were a little too far up their fundaments.  He will need to have the pacemaker battery replaced in seven or eight years. We'll check out what seems to be a decent cardiology hospital in Varna with a well-qualified interventional cardiologist, but if he doesn't feel confidence in them, we'll need to make sure we have more than enough set aside to get it done privately in the UK or possibly France (he speaks fluent French).

And we pray we stay well for everything else!

It seems based on our experiences with the NHS, it's very much luck of the draw. There are a few pockets of excellence, and a lot of mediocre and even dangerous care, delivered by staff who are either burned out by stress, ignorant, or think they're way too important to provide patient care. Unfortunately, private medical care in London is no better than NHS. I used to work for a big multinational company organising healthcare for their expats. Way too often, they got NHS care (or worse!) from the same consultants, but at a huge price. The only advantage was no wait, and a nicer private room. But my list of reliable consultants and hospitals I was happy to send people to was very short!