FINANCING LONG-TERM CARE FOR OLDER PEOPLE IN BULGARIA: PUBLIC RESPONSIBILITY, PRIVATE PARTICIPATION AND FAMILY SUPPORT IN A BALKAN CONTEXT

Abstract

Population ageing is one of the most significant demographic and social policy challenges facing Bulgaria and the wider Balkan region. The growing share of older people creates an increasing need for long-term care services that are accessible, affordable, financially sustainable, and effectively coordinated across the health and social sectors. In Bulgaria, the development of long-term care remains situated between public responsibility, private participation and family support, while the boundaries between formal services and informal care are often insufficiently defined. The purpose of this paper is to analyse the financing of long-term care for older people in Bulgaria, with a particular focus on the interaction between public funding, private service provision, household expenditure and family-based care. The study applies a narrative review and policy analysis approach, based on scientific literature, demographic trends, national strategic documents and comparative observations from European and Balkan long-term care systems. The methodological framework includes document analysis, comparative interpretation and conceptual assessment of the main financing mechanisms relevant to the Bulgarian context. The analysis indicates that the Bulgarian model of long-term care remains fragmented and insufficiently developed, with limited integration between health care, social services and community-based support. Public financing has a central role in guaranteeing equity, solidarity and protection of vulnerable groups, but its effectiveness is constrained by insufficient resources, institutional fragmentation and uneven regional availability of services. Private participation may contribute to additional capacity, service diversity, managerial flexibility and innovation, particularly in larger urban areas, but it also raises important concerns regarding affordability, regulation, quality control and equal access. At the same time, families continue to carry a substantial part of the real financial, social and emotional burden of care. This dependence on informal support creates hidden costs for households and may contribute to reduced labour market participation, gender inequalities and increased social vulnerability. The paper concludes that sustainable long-term care in Bulgaria cannot be achieved through a single source of financing. A balanced model is needed, combining predictable public investment, regulated private participation, targeted financial support for households and stronger coordination between health and social care institutions. In a Balkan context, the Bulgarian case reflects a broader regional challenge: how to develop quality long-term care systems in societies with ageing populations, limited public resources and strong traditions of family-based support. Recommendations include the development of mixed financing mechanisms, expansion of home-based and community-based care, clearer quality standards, improved data collection and stronger public-private cooperation under transparent state regulations.