NHIF Bulgaria: Expenditures and Patient Counts for Antineoplastic and Coagulopathy Medicines in Hospital Treatment

📊 Dataset Description Title: NHIF Bulgaria: Expenditures and Patient Counts for Antineoplastic and Coagulopathy Medicines in Hospital Treatment (🇧🇬 ИЗВЪН СТОЙНОСТТА НА КП/АПР – Приложение 2) Summary: This dataset contains detailed records of hospital-based expenditures and patient counts for antineoplastic (anti-tumor) medicines and medicinal products for congenital coagulopathies, reimbursed outside the value of clinical pathways or ambulatory procedures (КП/АПР) by the National Health Insurance Fund (NHIF) in Bulgaria. The data corresponds to Application 2 of NHIF's official reporting and provides insight into high-cost therapies administered in hospital settings across the country. Key Characteristics: Aggregated by hospital within Regional Health Insurance Offices (RZOK). Linked to NHIF reimbursement codes and ICD-10 diagnosis codes. Captures non-standard reimbursements, i.e. outside bundled pathway-based pricing schemes. Dual-currency columns (BGN and EUR) derived using the official fixed exchange rate of 1 EUR = 1.95583 BGN, with a currency flag indicating the original denomination (BGN for pre-2026 records, EUR from 2026 onward). Temporal Granularity: Data is available on a monthly basis, as indicated by the period variable. Each row represents a hospital-level report for a specific month. Data Cleaning and Preprocessing: The raw monthly XLS files (66 files, named in MM.YYYY format) were processed using R (version 4.5.1; tidyverse, readxl, janitor, lubridate) with a standardised pipeline that: Harmonised Bulgarian column names to English and R-compatible identifiers Padded hospital codes (РЦЗ) to a uniform 10-digit zero-padded format Derived RHIF region codes from hospital codes where the original РЗОК field was missing or invalid, recovering 197,759 region codes via hospital-to-region mapping Standardised hospital names using frequency-based deduplication within each hospital code Parsed temporal identifiers from filenames in MM.YYYY format Added dual-currency columns (costs_bgn, costs_eur) and a currency flag based on the reporting period All character variables have been preprocessed with the following transformations to ensure consistency and reduce noise in downstream analyses: Lowercasing all strings (except hospital names and ICD-10 disease names, which preserve original case) Trimming and squishing whitespace Removing quotes (" and ') Standardizing " - " to "-" Removing trailing punctuation Hospital names were additionally standardised by normalising common abbreviations (МБАЛ, УМБАЛ, СБАЛО, КОЦ, ЕООД, ООД, ЕАД, АД) and city name casing, then deduplicated by assigning the most frequent name variant within each hospital code. No records were imputed, modified, or excluded beyond removal of structurally redundant columns present in the source exports (Национален №). No records have missing region or cost data in the final processed dataset. Data quality validation identified: 4,612 potential duplicate records (defined as identical combinations of region, hospital code, NHIF code, period, and ICD code) 11 extreme cost outliers exceeding 10 times the 99th percentile of the reimbursement distribution 649 records with zero reimbursement amounts (0.1% of all records) Structure: 📦 Rows: 1,021,185 📁 Columns: 20 📆 Temporal coverage: July 2020 – December 2025 (66 months) 🌍 Geographical scope: All 28 NHIF regions and 54 contracted hospitals in Bulgaria 💰 Total reimbursement: 6,029,075,136 BGN (3,082,617,168 EUR) Records by year: 2020: 78,016 (7.6%) 2021: 161,617 (15.8%) 2022: 172,401 (16.9%) 2023: 192,426 (18.8%) 2024: 201,668 (19.7%) 2025: 215,057 (21.1%) Key Variables: Variable Description region_num Code of the Regional Health Insurance Office (RZOK), 1–28 region_name Name of the region (lowercase Cyrillic) hospital_code Unique code identifying the hospital (10-digit, zero-padded) hospital_name Name of the hospital (standardised) atc_code Anatomical Therapeutic Chemical (ATC) code atc_name International nonproprietary name (INN) of the substance nhif_code NHIF-specific code used for reimbursement market_name Commercial (trade) name of the product packaging Pharmaceutical dosage form concentration Strength or concentration of the active substance num_in_pack Number of units per package icd_code ICD-10 diagnosis code icd_name Diagnosis name (in Bulgarian) patients_num Number of insured persons (ЗОЛ) billed in the period pack_num Number of reimbursed packages costs Reimbursement amount in original currency (BGN pre-2026; EUR from 2026) period Reporting period (first day of the month, YYYY-MM-DD) currency Original currency denomination (BGN or EUR) costs_bgn Reimbursement amount standardised to BGN (1 EUR = 1.95583 BGN) costs_eur Reimbursement amount standardised to EUR (1 EUR = 1.95583 BGN) Use Cases: This dataset is suitable for: Health expenditure analysis in oncology and rare coagulation disorders Hospital-level treatment access monitoring Geospatial and temporal health inequality studies Pharmaceutical policy evaluation at the national and regional levels Health technology assessment and pharmacoeconomic modelling Longitudinal analysis of inpatient medication reimbursement trends Note: The unit of observation is an administrative reimbursement record aggregated at the facility–product–diagnosis–month level. The patients_num field counts insured persons billed for the given product within each stratum and does not represent unique patient identifiers across strata or periods. Source: National Health Insurance Fund (NHIF), Bulgaria — https://www.nhif.bg/ License: Unless otherwise specified, shared under Creative Commons Attribution 4.0 International (CC BY 4.0) Files included: nhif_inpatient_pharmacy_combined.csv — merged analytical dataset (UTF-8) nhif_inpatient_pharmacy_combined_metadata.csv — variable-level data dictionary with English and Bulgarian descriptions, source column mappings, data types, and value formats