site.btaHealth Minister Questions High Pay of State Hospital Directors amid Mounting Debts

The salaries of directors of some state-owned hospitals significantly exceed those of senior government officials despite poor financial performance and mounting debts at the institutions they manage, Health Minister Katya Ivkova told journalists on Friday at a press conference at her ministry.

Presenting financial data for several major state hospitals, Ivkova said the remuneration of some hospital executives remained high even as their institutions reported losses and accumulated substantial liabilities.

At Pirogov Emergency Hospital, revenue stood at EUR 25 million as of March 31, 2026, while expenditure totalled approximately EUR 24 million. Personnel costs accounted for 60% of spending. The hospital's liabilities exceeded EUR 41 million. The director's salary exceeded EUR 10,000 in January and EUR 12,000 in March.

At Alexandrovska Hospital, revenue amounted to more than EUR 21 million, while expenditure exceeded EUR 22 million. Total liabilities stood at more than EUR 60 million, including over EUR 3 million in overdue obligations. The director's monthly salary exceeded EUR 8,000.

At St. Ekaterina University Hospital, expenditure exceeded EUR 10 million and liabilities amounted to EUR 28 million, including more than EUR 2 million in overdue obligations. The director received more than EUR 8,000 per month.

At St. Naum Hospital in Sofia, revenue and expenditure were both close to EUR 2 million, while liabilities exceeded EUR 2 million. The hospital had no overdue obligations. The director's salary exceeded EUR 8,000 in January and EUR 10,000 in March.

At Ivan Kirov Infectious Diseases Hospital, revenue exceeded EUR 3.5 million and liabilities stood at more than EUR 5 million. The hospital had no overdue obligations. The director's salary exceeded EUR 14,000 in March.

At Lozenets Hospital, revenue was close to EUR 7 million and expenditure exceeded EUR 7 million. Liabilities totalled EUR 20.4 million, including EUR 492,000 in overdue obligations. The director's salary was EUR 8,500 in January and exceeded EUR 40,000 in March.

At Maichin Dom Hospital, revenue amounted to EUR 4.8 million and expenditure to EUR 4.9 million. Liabilities stood at EUR 11 million, including EUR 5 million in overdue obligations. The director's salary reached EUR 10,000 in March.

Ivkova said total liabilities of state-owned hospitals amounted to EUR 426 million as of March 31, including EUR 21 million in overdue obligations. Seventeen state hospitals have loan agreements with commercial banks, with total borrowing amounting to approximately EUR 96 million. More than half of those loans were issued by a single bank, while several additional hospitals signed loan agreements during the last quarter.

The minister said the results of an analysis of the performance of the boards of directors of all 64 state-owned hospitals were expected later on Friday.

State representatives serving on hospital boards receive between EUR 2,000 and EUR 4,500 per month on average, with some earning a combined monthly remuneration of EUR 8,000 to EUR 9,000 when board fees are added to their salaries. Ivkova said the methodology used to determine the remuneration of board members would be reviewed.

She also said that between the beginning of the year and the end of May, the Health Ministry's Internal Audit Unit had carried out 22 inspections focusing on the implementation of regulations governing treatment with medicines not authorized for use and on joint-management contracts.

Ivkova added that she had requested information on contracts between hospitals and various service providers and had found that some agreements contained revenue-sharing arrangements that favoured the external contractor rather than the hospital. In some cases, the ratio was as high as 20:80, with the larger share going to the contractor.

She said that findings from some of the inspections had already been referred to the Prosecution Office, the Public Financial Inspection Agency, the State Agency for National Security (SANS) and the National Construction Control Directorate (DNSK). Asked whether hospital directors could be replaced, Ivkova said it would be appropriate to wait for the responses from the competent authorities to the signals that had been submitted.

The minister also reiterated one of her key priorities: updating and digitizing the National Health Map. Plans include an inventory of hospital beds to verify whether their number corresponds to the facilities' operating licences.

A fully electronic hospital register will also be introduced, along with daily monitoring of bed availability by category and region, in an effort to end the practice of refusing patient admissions, she said. To curb the continued growth in the number of hospital beds, a comprehensive analysis of the utilization of existing bed capacity across the hospital system will be carried out.