OBJECTIVES : To analyse the differences in household and public healthcare and pharmaceutical expenditures during 2016-2019 in Bulgaria.

METHODS : A comparative, retrospective, observational, and macroeconomic analysis was performed. National Statistical Institute (NSI) and National Health Insurance Fund (NHIF) databases were analyzed. Household and public healthcare and pharmaceutical expenditures were systematized and statistically proceeded.

RESULTS : Household spending is increasing more than twice in some of the observed categories. The pharmaceuticals' spending has arisen from 229 to 280, those for herbal, homeopathic medicines and food supplements - from 3.57 to 7.65, medical devices and equipment - from 14.79 - 26.52, out-patient services - from 39 to 44, dental services - from 17 to 21, laboratory analysis and x-ray examinations increase from 5 to 6 euro, and hospital services -from 24 - 66 euro average per household annually. Overall growth of healthcare services cost is about 35 %. The public expenditures for reimbursed medicines, food supplements, and medical devices increased - from 365 in 2016 to 420 mln euro in 2019 with rate almost 15 %. All changes were found statistically significant.

CONCLUSIONS : The households and public healthcare and pharmaceutical expenditures are progressively increasing with higher rate for public ones but still the burden on families is heavy. The introduction of cost containment measures could ensure more affordable medical services as well as better clinical results.