The Institute for Market Economics (IME) presents an analysis titled “Financial state of Bulgarian hospitals: Revenues and expenditures, assets and liabilities of state and municipal hospitals.”
The number, territorial distribution, and operation of hospitals are frequent topics of public debate in Bulgaria. The issue arises from difficulties in finding an appropriate formula for restructuring hospitals both territorially and in terms of the scope of services. The comparative analysis of their financial condition reveals interesting trends:
- Bulgarian hospitals conduct over 2 million hospitalizations annually, generate nearly 3 billion BGN in revenue, and employ around 50,000 staff. The extensive network of state and municipal hospitals (189 total) is too large for the shrinking population but reflects the strong focus of healthcare on hospital services.
- There are significant differences between state and municipal hospitals across all financial indicators, with state hospitals accounting for around 70% of total expenses.
- The COVID-19 crisis has had a positive financial impact on most healthcare institutions, with both revenues and profits rising significantly after 2019.
- Hospitals manage assets valued at approximately 2 billion BGN, though some assets are already depreciated and are not being updated. Liabilities have slightly increased in recent years, with short-term liabilities prevailing.

What should the path to more efficient hospital care be?
- Gradual reduction of the network of hospital facilities and concentration of services and staff, with consideration of a mechanism to provide quality healthcare services to more remote areas.
- Adjustment of the funding mechanism (clinical pathways), ensuring fair compensation based on the case severity.
- Stronger financial oversight of hospital operations to limit potential abuses and irregularities.
The study was conducted with the informational support of our partners at iUX (https://iux.bg/). Aggregated information from the accounting reports of state and municipal healthcare institutions in Bulgaria was used.
A link to the full analysis can be found here.