The Ministry of Health is the controlling and policy-making agency for the health system in Bulgaria. In 1999, an estimated 4% of GDP went to health expenditure. In 1991, the Bulgarian government passed a bill restoring the right of the private sector to practice medicine and permitting the establishment of private pharmacies, dentists, and opticians. Bulgarian citizens resident in the country still have use of the free national health service. Bulgaria is in the process of restructuring its health care system from one based on command and control to one founded on pluralism. Medical care has never been well funded, but the shift from a centrally planned to a private enterprise system has left the medical sector in disarray. Doctors continue to receive low wages and operate inadequate and outdated machinery and patients on the whole receive minimal health services. In 1993, the World Bank assessed the country's problems and recommended numerous changes and improvements. The Ministry of Health sought funding for 19–21 additional health centers and the rehabilitation of 67 secondary centers served by 283 emergency medical teams. Utilization of health care services, including hospitalization, outpatient treatment, and preventive care, declined throughout the 1990s.
In 1999, Bulgaria had 98 municipal hospitals with an average of 227 beds apiece, and 32 general district hospitals with an average of 874 beds. In addition there were 12 university hospitals in Sofia. As of 1999, there were an estimated 3.5 physicians and 8.6 hospital beds per 1,000 people. In 1997 there were a total of 28,655 physicians in the public health sector. Mortality in 1999 was 13 per 1,000 (compared with 8.1 in 1960).
Stroke mortality is among the highest in Europe and circulatory diseases account for more than half of all deaths. Smoking is on the increase; alcohol consumption is high; physical activity is low; and obesity is common. Bulgarians have a high intake of fats, sugars, and salt. One out of eight people has high blood pressure. Improved maternal and child care lowered infant mortality from 108.2 per 1,000 in 1951 to 13 per 1,000 in 2000. In 1999, there were 46 cases of tuberculosis per 100,000 people despite high immunizations for this disease. In the same year Bulgaria immunized children up to one year old as follows: diphtheria, pertussis, and tetanus, 96%, and measles, 96%. There were 75,221 births in 1999. From 1980 to 1993, an estimated 76% of married women (ages 15 to 49) used contraception. The fertility rate has deceased from 2.2 per woman in 1960 to 1.3 per woman in 2000. Bulgaria's maternal mortality rate is below the average for countries of medium human development. As of 1998, an estimated 15 women died in pregnancy or childbirth per 100,000 live births. In 1990, 99% of the population had access to safe drinking water. Life expectancy in 2000 was 72 years on average. In 1994, there were 39 AIDS cases. As of 1999, the number of people living with HIV/AIDS was estimated at 346 and deaths from AIDS that year were estimated at fewer than 100. HIV prevalence was 0.01 per 100 adults.