care pathway includes basic medical activities to relive the patient's condition. In total, 25 hospitals in diseases (EAPC, 2025[231) In 2021, Bulgaria had 47 hospices, funded through private mechanisms, with 1 175 beds providing palliative care to people with cancer and other chronic conditions (IPAAC, 2021[241). According to the Ministry of Health, there are 29 hospices which have a contract with the NHIF for palliative stage of heart attack or after cardiac intervention, 82 for long-term treatment after surgical intervention with large and very large volume and complexity and with residual health problems. According to the Executive Agency Medical Supervision registry, 52 hospices are registered to the Public Register of Outpatient Care Facilities and Hospices (National Health Information System, 2025[25]). However, these positive developments have been insufficient. Palliative care is uneven, uncoordinated, insufficient and not well integrated across the healthcare system, mainly as a result of limited public investment and low service capacity (OECD, 2023[8j; IPAAC, 2021[24). In Bulgaria, 15% of people who died aged 65 and used palliative care or hospice before death, while it rises up to 65% in the OECD countries (OECD, 2023[26]). Palliative care patients are mainly cared by their families, mainly due to financial reasons (IPAAC, 2021[241), which is insufficient to cover the complex needs of end-of-life care. Estimates show that only 5% of all terminally ill cancer patients in Bulgaria received palliative care in 2020. In the Global Atlas of Palliative Care (WHPCA, 2020[271) Bulgaria is defined as belonging among the lowest 25% of countries in terms of development of palliative care activities in several locations, with growth of local support in those areas; multiple sources of funding; availability of morphine; several hospice palliative OECDREVIEWSOFHEALTHSYSTEMS:BULGARIA2026?OECD2026