The silent Apocalypse: the cult of profit is killing healthcare (part 2) - Cross-border Talks

Darina K., Levfem, 27 August 2026

Summary

The silent Apocalypse: the cult of profit is killing healthcare (part 2) presents a critical analysis of Bulgaria’s healthcare system over the past 30 years, arguing that a profit-driven capitalist ideology has eroded public health, exploited workers, and prioritized financial gain over human life.

• Systemic Failure & Patient Burden: Healthcare commercialization has turned medical care into a commodity. Over 1.3 million Bulgarians delay care due to costs, nearly 70% of cancer patients pay out-of-pocket, and profit-driven private hospitals routinely divert complex, costly cases to overburdened state facilities.
• Exploitation & Staff Shortages: The system suffers from a deficit of at least 20,000 medical professionals. Frontline staff face low pay and severe overwork, while legal frameworks allow hospital directors to extract high monthly earnings.
• Public Subsidies & Lack of Transparency: Private hospitals draw heavily on public funds (25% of the National Health Insurance Fund), yet evade public procurement transparency rules applied to state institutions, leading to inflated costs and drained public resources.
• Institutional Resistance: Attempts to regulate the sector have faced strong pushback. The National Association of Private Hospitals successfully fought legal challenges against healthcare quality standards and blocked a €260 million NHIF allocation intended to raise baseline salaries for medical staff.
• The Trap of Individualism: Public initiatives like Caps for the Future and charity drives normalize a “DIY” approach to healthcare, framing life-saving treatment as a matter of individual charity rather than a fundamental human right.
• Call to Action: The author concludes that healthcare workers cannot fix the system alone. Overcoming the crisis requires rejecting market-driven individualism in favor of collective, society-wide political action to restore healthcare as a public good.

Article

The crisis facing healthcare workers and the extreme urgency of the situation in our country’s healthcare system have consequences for us all. The lack of widespread public outrage on this issue may be due to many factors. On the one hand, people are too preoccupied with their own survival. Consequently, they have neither the time nor the inclination to forge links with others in the same predicament. On the other hand, our society is so steeped in faith in capitalism that it refuses to see its failures.

Looking at the state of the Bulgarian healthcare system over the last nearly 30 years, what we see are the results of a deadly ideology. An ideology that values money above all else, including life itself.

A completely preventable crisis

In 2010, a man in Kalofer died of a heart attack after being denied an ambulance because he had no health insurance. According to data for 2025, 1,300,000 people in Bulgaria are postponing healthcare due to a lack of funds. Nearly 70 per cent of cancer patients have to pay extra for treatment out of their own pockets – if they have anything to spare. These things are not inevitable laws of nature. These are political decisions based on specific understandings of the world and values. The question of society’s values and priorities is political and, more specifically, ideological.

In 2019, protesting nurses first drew public attention to the harmful effects of the commercialisation of healthcare. In 2024, following the closure of the neonatal unit in Lovech, Dr Stancheva commented: “Why have they turned us into businesspeople, run by fictitious boards that are leading us to bankruptcy? I am ashamed; it is cynical that, in order to secure my salary, I have to hope there are many seriously ill children for me to treat.”

The fact that private hospitals profit at the expense of people’s health creates an inherent contradiction. Profit does not lead to better quality care, but quite the opposite. It is well known that private hospitals often do not take on more serious cases, which require more time, effort and treatment costs. They refer them to municipal and state hospitals, which are already overwhelmed by such cases.

The profit motive – and indeed the requirement for profit within this model – leads to cutbacks in care and, above all, in the salaries of the specialists on whom our health depends. Thanks to these ‘savings’, a handful of nurses are working overtime, exhausted and humiliatingly underpaid. Our system is short of at least 20,000 medical professionals needed to provide adequate care for the number of patients.

Health as a commodity, healthcare – a business

Whether we are talking about private hospitals or not, all hospitals in our country are currently commercial enterprises. The cementing of healthcare as a business, rather than a public good, is the ideological choice. The justifications for this model are that the free market will manage resources more efficiently and ‘more fairly’. But for years now, we have all seen that this is far from reality, and we are paying the price with our health.

In 2025, Dr Boyan Kunev stated in an interview with bTV: “It does not appear that there is transparent regulation regarding private hospitals, which are not obliged to fulfil public procurement contracts [for medicines]. And secondly, the money disappears through unexplained channels and never reaches the state hospitals.”

Petar Dimitrov raises the same issue today in the healthcare journal LexMedica News: private hospitals continue to receive billions of leva in public funds from the National Health Insurance Fund without being subject to the same rules on transparency regarding their expenditure on medicines as those imposed on state and municipal hospitals. This leads to significant price differences for the same products. Market-based negotiation effectively results in deals that favour friendly companies and, consequently, drain the National Health Insurance Fund at the expense of everyone else.

Resistance from the powerful

Over the years, there have been attempts to put an end to these unfair practices, but they have always come up against a brick wall. Some time ago, the Court of Justice of the European Union ruled that European law does not, in itself, require private healthcare facilities to be regarded as ‘public-law organisations’. Consequently, the EU does not oblige them to be included in the public procurement regime. It is emphasised, however, that Bulgaria has the right to exercise its own discretion and take measures on this matter. Such attempts, however, are thwarted by other stakeholders, including the Bulgarian Medical Association.

The very fact that hospital directors – including those in state-run hospitals – quite legally earn tens of thousands of euros a month is telling. No, none of this is corruption; this is the ‘efficiency’ of the market model.

Under capitalism, the work of bosses is deemed to be worth dozens of times more than the labour of the people on whom our health and lives depend. Dozens of times more valuable than the labour of those who work gruelling shifts during unbearable hours.

Who stands to gain… and who stands to lose?

This model turns our health into a commodity from which businessmen and bosses profit for their own gain. On the other hand, it turns out that they actually profit not because of the inherent superiority of private financial management over public management, but from public funds, with no restrictions on how they are spent. The data from ‘Diagnosis Bulgaria’ also shows that a quarter of the National Health Insurance Fund’s budget goes to private hospitals. A large proportion of this clearly does not benefit society, but goes straight into the pockets of directors and owners.

Against this backdrop, the National Association of Private Hospitals (NAPH) challenged in court the healthcare standards requirements, first introduced in October 2025. The regulation provided not merely for a grace period, but for a full ten years to meet the requirements in question. They also successfully opposed the targeted allocation of 260 million euros from the National Health Insurance Fund (NHIF) for staff salaries, aimed at guaranteeing decent fixed salaries, particularly for young specialists.

When they receive money from the public budget, private hospitals have no objections. However, when regulations are finally adopted that require investment on their part, the National Association of Private Hospitals (NSPH) strongly opposes them. Instead of investing resources in meeting basic standards of healthcare, private hospitals chose to take the state to court. And they succeeded.

‘Every man for himself’

Unfortunately, the campaigns for change in the sector led by medical professionals in recent years have not received sufficient widespread support from the general public. Although the public appears to sympathise with their cause, this sympathy has so far failed to lead to a deeper recognition of the problems as shared concerns.

The LevFem study “Who cares about care?” highlights feelings of demotivation amongst care workers. There is also frustration at the lack of solidarity between different sectors and on the part of patients. It is high time that this sympathy escalated into more serious public discontent and corresponding action.

Caps with no future

The closure of hospitals and the deprivation of hundreds of thousands of people of access to vital healthcare is a social problem. Nevertheless, a culture of individualism prevails in our country, in which this problem is experienced as a personal struggle for survival rather than a collective struggle for change.

This leads to piecemeal solutions, which also require enormous effort but yield results for only a few.

Examples of this include the ‘Caps for the Future’ phenomenon and all attempts to raise funds through donations from friends, acquaintances, neighbours and via collection boxes in shops and restaurants. The national charity concert ‘Bulgarian Christmas’ turns the political issue of the lack of adequate funding into yet another spectacle.

All these examples normalise this DIY approach to fundraising as an acceptable financial model for healthcare in our country. Whether intentionally or not, this normalises the idea that access to life-saving healthcare, including for children, is a matter of charity and alms. Instead, we must all decide that this is, in fact, a fundamental right, a core value and a public priority.

The Struggle for Values

It is clear that even the most fundamental measures, such as standards in healthcare, require a tremendous struggle and constant advocacy to be implemented. The resistance from private interests is relentless. They defend their profits and do not easily relinquish their ‘right’ to take from our public funds.

We cannot leave healthcare professionals to wage these unequal and gruelling battles on their own. A collective effort is needed if we are all to enjoy a functioning and high-quality healthcare system. We must reject the individualistic mindset that ‘every man for himself’. We must also be able to speak out about the sacrifices demanded by capitalism. Solutions do exist, but we will have to fight for them not piecemeal, but collectively, as a society.

This series of articles is funded by the Economic Opportunities Fund of the Alliance for Gender Equality in Europe. The text does not reflect the views of the funding organisation, which accepts no responsibility for its content.

Photo: (source: Unsplash, Credit: Photo by Marcelo Leal on Unsplash)

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