10 leva for an apology note are forced to pay parents in Sofia. The Health Insurance Fund does not cover the issuance of a medical document for excusing absences in kindergarten and school.

There is no regulation for determining the prices of services that patients pay extra. The only requirements for medics and medical institutions are to announce a price list for additional services and to issue receipts.

In Sofia, the price of the apology note varies from 2 to 10 leva.

Nearly 40,000 electronic apology notes have been issued since the beginning of the school year.

"The problem with colleagues with pediatric practices that have mostly children is that there are no user fees. And they are trying to somehow put some fees to compensate for this lack of user fee. One way is a fee on the medical note," Dr. Mihail Mihov, Chairman of the Society of Sofia General Practitioners, told BNT.

"There is no regulation of how pricing is implemented. There is no ceiling on these prices or any other restrictions, "explained Maria Sharkova - a lawyer in medical law.

Thus, if the child falls ill and the doctor has introduced a fee "apology note" parents must pay it regardless of the price.

"These are documents that are necessarily required by school authorities or kindergartens and nurseries. That is, the patient cannot choose whether to take advantage of this service, "said Maria Sharkova.

"It certainly affects the budget of parents regardless of the number of children. There are children who get sick more often. 10 leva is a serious amount. The question here is whether it is really necessary for these notes to exist. This is not a practice spread in Europe", commented Plamena Nikolova - Director of Policies for Children, National Network for Children.

In Europe, absences of up to a week due to illness are apologised with a declaration from parents, the National Network for Children said.

"Notes are a matter of the educational or social system if a child is systematically not walking or absent and so on. There the health system has nothing to do, "said Plamena Nikolova - Director of Policies for Children, National Network for Children.

Doctors and lawyers offer different options to solve the problem.

"To introduce a user fee for children, to be paid by the state," said Dr. Mihail Mihov, Chairman of the Society of Sofia Doctors in Sofia.

The Health Ministry did not answer our questions, and the Health Fund explained that the package of activities it pays is determined by the Health Minister.

medical note