“How Much Did We Pay for COVID-19 Treatment at Pirogov, and What Followed?”
From mid-March, when the state of emergency was declared, until the end of 2020, the Bulgarian government spent 3.4 billion BGN from the national budget and EU funds to support the healthcare system and mitigate the socio-economic impact of the COVID-19 crisis. At least, that’s what the official data shows. However, the results of the fight against the coronavirus pandemic did not justify this enormous public expenditure. Statistics place Bulgaria among the countries with the highest COVID-19 mortality rates in the world.
The interim government, due to its short mandate, was unable to conduct a full review of these expenditures, which would have shed light on how the funds were allocated during the first year of the pandemic. An analysis by the Bulgarian Institute for Legal Initiatives (BILI), titled “Transparency and Efficiency of Public Funds for Tackling COVID-19 in Bulgaria: Corruption Risks and Measures in Pandemic Management,” attempts to fill this gap by compiling a vast amount of data. Some of the practices and abuses highlighted in the report were later confirmed by the interim cabinet.
Yet, questions like how the cost of a single PCR test was determined — ranging from 50 to 120 BGN across different cities and laboratories and starting at 130 BGN at the pandemic’s onset — remain unanswered.
All information about the expenditures of healthcare facilities in Bulgaria, as well as the funds they receive from the National Health Insurance Fund (NHIF), the Ministry of Health (MoH), and donors, is considered public under the Access to Public Information Act (APIA). Nevertheless, few hospitals provide this information when requested by institutions, media, or citizens.
The University Hospital for Emergency Medicine “N.I. Pirogov” initially refused to release such data to BILI. However, following a ruling by the Sofia Administrative Court on July 23 of this year in a case filed against the refusal, the hospital was compelled to prepare the report — albeit after the analysis had already been completed and published.
It’s worth noting that the hospital also declined a similar APIA request from For the Truth regarding donations made by the individual Delyan Peevski or his companies.
The detailed report provided by Professor Dr. Ivan Poromanski, executive director of one of Bulgaria’s leading hospitals specializing in emergency and disaster medicine, sheds light on the hospital’s operations and spending between March 13, 2020, and January 31, 2021.
“Pirogov” operates five clinics and departments for anesthesiology and intensive care, with 75 beds and 90 ventilators. At the pandemic’s onset, the hospital expanded its capacity to 420 beds for moderate cases and 58 for invasive care, treating 27,923 patients during this period, of whom 3,627 were COVID-19 cases.
In 2020, the hospital reported 1,638 patient deaths, including 410 from COVID-19, compared to 1,594 deaths in 2019. Funding discrepancies complicate mortality rate calculations: if the 2,387 patients treated for COVID-19 under clinical pathway 104 are the actual figure, the mortality rate stands at 17%. However, if the figure of 3,627 patients is correct, the mortality rate drops to 11%. Both rates, however, significantly exceed Bulgaria’s national average of 4% during the same period.
The National Health Insurance Fund (NHIF) reimbursed Pirogov 2.745 million BGN for 2,397 COVID-19 patients under clinical pathway 104. Questions remain about the funding for the remaining 1,130 patients, as the hospital confirmed that only 50 of its 275 uninsured patients in 2020 had COVID-19.
Between March 2020 and January 2021, Pirogov received over 30 million BGN from the NHIF and Ministry of Health for various pandemic-related expenses, including frontline worker bonuses, vaccine distribution, and PCR testing. Additionally, the hospital distributed 3.36 million BGN in bonuses to staff, including non-medical personnel such as maintenance workers, without providing transparency on the allocation criteria.
Under the State of Emergency Measures Act, public procurement rules were relaxed, allowing direct negotiations and shortened procedures. Pirogov signed 75 contracts for medical equipment totaling nearly 10 million BGN, but questions about market pricing and procurement transparency persist. For instance, a mobile X-ray machine was purchased at a price exceeding the market maximum by 4,000 BGN.
Despite these substantial expenditures, Bulgaria’s Public Financial Inspection Agency (PFIA) did not conduct any inspections into pandemic-related spending at Pirogov during this period. This lack of oversight raises concerns about accountability, particularly given the significant public resources allocated.
The findings call for a deeper audit of Pirogov’s spending and management of COVID-19 funds, potentially under the directive of interim Health Minister Dr. Stoycho Katsarov. Such an investigation could provide answers to lingering questions about resource allocation, financial accountability, and governance within Bulgaria’s healthcare system.
Venelina Popova contributed to the analysis by the Bulgarian Institute for Legal Initiatives (BILI).
