In 2000 the International Monetary Fund (IMF) and World Bank insisted on changes to the Bulgarian healthcare system, without any real public debate. Polyclinics were replaced with a GP (general practitioner) service and finance was changed from general taxation to a 6% insurance contribution.

The system suffers from underfunding and emigration of staff to other countries due to poor pay. The Multiprofil hospital in Gabrovo, a town at the centre of Bulgaria, is an example of how public healthcare has not only survived but consciously improved services to patients in Bulgaria, based on active involvement of staff, dialogue with patients, and positive relations with unions. Salaries and staffing levels have been increased, and the hospital continues to treat patients whether they have insurance or not.