Telemedicine as a means to overcome health inequalities in Bulgaria
Keywords:
digital healthcare, remote communities, access to medical services, mobile health teams, healthcare infrastructure, telemedicineAbstract
Telemedicine is emerging as a promising tool for addressing the long-standing healthcare inequalities in Bulgaria, particularly in the rural and remote areas where access to medical care is severely limited. This review explores the potential of digital health solutions to improve access to healthcare services for vulnerable population groups. The analysis is based on national data as well as international best practices. Special attention is given to the serious workforce and infrastructure imbalances in the Bulgarian healthcare system – such as the shortage of physicians, limited coverage by healthcare facilities, and poor transportation access to medical services. In this context, successful telemedicine models are presented from various parts of the world. The review highlights the wide range of telemedicine applications, including remote medical consultations, real-time monitoring of chronically ill patients (telemonitoring), mobile health units, and initiatives to improve digital health literacy. These approaches have the potential to enhance both the accessibility and quality of healthcare services, especially in locations where on-site medical staff are scarce or entirely absent. Implementing telemedicine in Bulgaria requires a clear strategic framework, encompassing regulatory reforms, training for healthcare professionals, and long-term financial support. If properly introduced, this model could play a key role in ensuring more equitable access to healthcare and improving health outcomes across the country.
References
WHO Global Observatory for eHealth. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth. Geneva, World Health Organization, 2010, 9. https://iris.who.int/handle/10665/44497.
European Commission. Digital health and care. Luxembourg, Publications Office of the European Union, 2023. https://health.ec.europa.eu/ehealth-digital-health-and-care/digital-health-and-care_en.
Kilova K. The application of telemedicine in Bulgaria in the conditions of COVID-19. Fresen. Environ. Bull., 2021, 30(7A):9180-9187. https://www.researchgate.net/publication/355186586_The_application_of_telemedicine_in_Bulgaria_in_the_conditions_of_COVID-19.
Smith AC, Armfield NR. Telehealth a game changer: closing the gap in remote Aboriginal communities. Med. J. Aust., 2019, 211(1):43-43.e. DOI: 10.5694/mja2.50208.
European Commission. Country Health Profile: Bulgaria 2021. State of Health in the EU. Luxembourg, Publications Office of the European Union, 2021, 5–6. https://health.ec.europa.eu/system/files/2022-01/2021_chp_bulgaria_bulgarian.pdf.
Национален център по обществено здраве и анализи. Доклад за здравето на гражданите и изпълнението на Националната здравна стратегия за 2020 г. София, НЦОЗА, 2020, 45. // National Center of Public Health and Analyses. Report on the health of citizens and implementation of the National Health Strategy for 2020. Sofia, NCPHA, 2020, 45.
Национален статистически институт. Здравеопазване 2024. София, НСИ, 2024, 9-15. ttps://www.nsi.bg/sites/default/files/files/publications/Zdraveopazvane_2024.pdf.
Василева М. Здравни грижи, 2024, 7:1–5. София, БАПЗГ, 2024. // Vasileva M. Health Care, 2024, 7:1–5. Sofia, BAPZG, 2024. https://nursing-bg.com/docs/bzg/2024/Zdravni_griji_07_2024.pdf.
Gagnon MP, Ouellet S, Attisso E et al. Wearable Devices for Supporting Chronic Disease Self-Management: A Scoping Review. Interact J Med Res. 2024. https://www.i-jmr.org/2024/1/e55925.
Smith AC, Armfield NR, Caffery LJ. Telehealth a game changer: closing the gap in remote Aboriginal communities. Med. J. Aust., 2019, 211(1):43–43.e1. https://doi.org/10.5694/mja2.50208.
Dastidar BG, Jani AR, Suri S et al. Reimagining India’s National Telemedicine Service to improve access to care. Lancet Reg Health Southeast Asia. 2024; 30:100480. https://www.thelancet.com/journals/lansea/article/PIIS2772-3682(24)00130-6/fulltext.
Sten-Gahmberg S, Pedersen K, Harsheim IG et al. Pragmatic randomized controlled trial comparing a complex telemedicine-based intervention with usual care in patients with chronic conditions. Eur. J. Health Econ., 2024, 25(7):1275–1289. https://doi.org/10.1007/s10198-023-01664-w.
World Health Organization. Maria’s first-hand experience: how telemedicine brings health care closer to remote Swedish villages. WHO Newsroom. 23 May 2023. https://www.who.int/europe/news/item/23-05-2023-maria-s-first-hand-experience--how-telemedicine-brings-healthcare-closer-to-remote-swedish-villages.
Naverlo S, Carson DB, Edin-Liljegren A et al. Patient perceptions of a Virtual Health Room installation in rural Sweden. Rural Remote Health. 2016; 16(4):3823. https://doi.org/10.22605/RRH3823.
Dubois H, Bergenmar M, Härgestam M et al. Patient participation in tele-emergencies: experiences from healthcare professionals in northern rural Sweden. Rural Remote Health. 2022; 22:7404. https://doi.org/10.22605/RRH7404.
Ärlebrant L, Dubois H, Creutzfeldt J et al. Emergency care via video consultation: interviews on patient experiences from rural community hospitals in northern Sweden. Int J Emerg Med. 2024; 17:109. https://doi.org/10.1186/s12245-024-00703-4.
BMC Health Services Research. Telemedicine in Swedish primary health care: a web-based survey. BMC Health Serv. Res., 2023, 23:9133. https://doi.org/10.1186/s12913-023-09133-z.
Väisänen V, Satokangas M, Huhtakangas M et al. Medical deserts in Finland: measuring the accessibility and availability of primary health care services. BMC Health Serv Res. 2025; 25:281. https://doi.org/10.1186/s12913-025-12409-1.
Savi V. Impact of telehealth on healthcare resource utilization during the COVID-19 pandemic in Finland [master’s thesis]. Kuopio (Finland), Savonia University of Applied Sciences, 2023. https://www.theseus.fi/bitstream/handle/10024/796559/Savi_Victor.pdf.
Rosenlund M, Kinnunen UM, Saranto K. The use of digital health services among patients and citizens living at home: a scoping review. J Med Internet Res., 2023, 25:e4471. https://doi.org/10.2196/44711.
Koehler F, Koehler K, Deckwart O et al. Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet. 2018;392(10152):1047–57. https://doi.org/10.1016/S0140-6736(18)31880-4.
Koehler F, Winkler S, Schieber M, et al. Telemonitoring of heart failure patients is reimbursed in Germany. J. Med. Internet Res., 2022, 24(11):e38944. https://doi.org/10.2196/38944.
Geriatric Health Centres of the City of Graz. Facilities & Services. Graz, GGZ. https://ggz.graz.at/en/home-en/.
Kouskoukis MN, Botsaris C. Cost-benefit analysis of telemedicine systems/units in Greek remote areas. Pharmacoeconomics Open, 2017, 1(2):117–121. https://doi.org/10.1007/s41669-016-0006-z.
BioSpace. Institute for Healthcare Improvement recognizes NHS Highland telehealth program. BioSpace News, 2019 Nov 19. https://www.biospace.com/institute-for-healthcare-improvement-recognizes-nhs-highland-telehealth-program.
Wolf Theiss. Medical Devices in CEE & SEE: Navigating the Challenges to Modern Healthcare – Bulgaria. December 2024. https://www.wolftheiss.com/app/uploads/2024/12/Medical_devices_in_CEE_SEE_guide_Bulgaria.pdf.
Dimitrova M, Dimitrov R, Ahchiyska K, et al. Digital health in Bulgaria: imagination or possible reality? Pharmacia, 2023, 70(3):649–655.https://pharmacia.pensoft.net/article/108957/.
Министерство на здравеопазването. Национална стратегия за електронно здравеопазване и дигитализация на здравната система 2030 г. София, Министерство на здравеопазването, 2023, 15–17. // Ministry of Health. National Strategy for eHealth and Digitalization of the Health System 2030. Sofia, Ministry of Health, 2023, 15–17. https://www.strategy.bg/StrategicDocuments/View.aspx?Id=1666&lang=bg-BG.
Национален статистически институт. Използване на информационни и комуникационни технологии в домакинствата и от лицата през 2024 година. София, НСИ, 2024. // National Statistical Institute. Use of information and communication technologies in households and by individuals in 2024. Sofia, NSI, 2024. https://www.nsi.bg/sites/default/files/files/pressreleases/ICT_hh2024_5UX6GMY.pdf.
Медицински университет – Пловдив. Свободноизбираем курс за студенти по медицина от 1-ви до 6-и курс. Пловдив, МУ – Пловдив, 2022. // Medical University – Plovdiv. Elective course for medical students from 1st to 6th year. Plovdiv, MU-Plovdiv, 2022. https://mu-plovdiv.bg/svobodnoizbiraem-kurs-za-studenti-po/.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 A. Gamisheva-Vechernikova, A. Pramatarov (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
You are free to share, copy and redistribute the material in any medium or format under these terms.
