The Bulgarian Medical Association has opposed the double standard in healthcare

“The Bulgarian Medical Association expresses serious concern regarding the intention to consider amendments to the Public Procurement Act affecting the status of private hospitals at the second reading at the last minute and without the necessary expert and public debate. Their activation at this moment creates a sense of haste and ‘eleventh-hour’ legislation that fails to account for the long-term consequences for the healthcare system and patients.” This was stated in a position paper by the professional organization of physicians in Bulgaria.

According to the BMA, the argument that private hospitals spend public resources cannot justify a selective approach. In this regard, the organization notes that medicines, which constitute a significant portion of healthcare expenditures, remain outside the scope of such regulations. This, according to the union, raises legitimate doubts about the existence of a double standard and the directing of regulatory pressure solely toward private medical facilities.

The BMA emphasizes that an impression is being created of targeted attacks against private hospitals, despite the fact that they are an integral part of the healthcare system and are subject to the same control as all other medical facilities contracted with the National Health Insurance Fund. Approximately 40% of the country’s doctors and healthcare specialists work in the private sector, where a significant portion of Bulgarian patients are treated.

The risk of sanctions from the European Commission is cited as an argument for the proposed changes. According to the BMA, the Commission has currently only stated its intention to file a claim before the Court of Justice of the European Union, and Bulgaria has a real and objective chance of winning such a case. In the presence of pending legal proceedings, legislative changes are not recommended, as the CJEU is the ultimate arbiter of the dispute.

The professional organization recalls that, according to Directive 2014/24/EU, a “body governed by public law” is one that is established for the specific purpose of meeting needs in the general interest, not having an industrial or commercial character, has legal personality, and is financed or controlled primarily by public authorities. Private hospitals in Bulgaria do not meet these criteria and should not be automatically equated with bodies governed by public law, nor should the state be accused of non-compliance with European law on this basis.

In support of this position, the BMA also points to a decision by the Court of Justice of the European Union from December 2024 in case C-550/23, which confirms the existing approach to the definition of a “body governed by public law” and emphasizes Bulgaria’s right to adapt its legislation to national specifics and needs.

In conclusion, the Bulgarian Medical Association insists that legislative changes in healthcare be based on legal clarity, equality, and a real impact assessment, rather than political urgency and a selective approach, which deepen tension within the system and do not lead to better patient care.