After the success of the “Black Track” platform, which focused on road safety issues, Martin Atanasov is turning his attention to an even more sensitive topic – the spending of public funds in healthcare. His new platform “Diagnoza Bulgaria” collects and analyzes official data on state and municipal hospitals, showing serious differences in the prices of medicines, public procurement and financial management. Where does the data come from, how is it processed and why transparency is the first step towards real change... Martin Atanasov speaks to FACTI.
- Mr. Atanasov, the accidents that claim victims, or the bad healthcare is worse for Bulgarians?
- I wouldn't compare them that way. In both cases, behind the statistics are real people and families, their lives. We need to show genuine empathy and humility when it comes to this. The difference is that in a disaster, the tragedy is immediately visible - there is a specific place, a specific day, a specific victim. In healthcare, the consequences are sometimes quieter. It can be delayed treatment, a lack of specialists, nurses who leave, or resources that do not reach the place where they are needed most.
The commonality between the two topics is that very often we talk about “individual cases“, while the data shows recurring problems. That is exactly what I am trying to do with both projects - to collect the individual cases and show the whole picture. And where they are repeated.
- You created “Black Track“ and well You pushed the state to create other maps for the catastrophes. Now you have challenged the Minister of Health Katya Ivkova with the money in healthcare. Where is the state failing when we talk about money for health?
- The challenge is systematic, it is not directed at one, another or the next minister. In my opinion, the state is failing mostly between the collection of information, its processing and in an understandable form and its actual use. There is a lot of data. There are financial reports, public procurement, payments from the Health Fund, data on medicines, clinical pathways and personnel. However, they are scattered between different institutions, published in different formats and rarely viewed together. Even more rarely do they talk to each other and discover regular repetitions.
So in practice, institutions can have the information, but the public can hardly understand what it shows. And often the institutions themselves do not use it well enough for comparison and prevention.
After the presentation of the platform We held working meetings with the Ministry of Health and the NHIF. For me, this is a positive step, because the goal is not to quarrel with the institutions, but for the data to start leading to checks, explanations and better lasting solutions. I discussed with them possibilities for technological integration and provision of additional official data. Support has been promised.
- How are public funds spent in healthcare, because we are talking about billions, and what are the differences in the prices of medicines between individual hospitals? Is this the emphasis of the new platform?
- This is one of the main accents, but not the only one. “Diagnoza Bulgaria“ has collected data on 180 state and municipal hospitals. You can see their budgets, liabilities, public procurement, prices of medicines, payments from the NHIF, costs for external services and data on staff remuneration.
The most important thing is that hospitals are not considered isolated.
A hospital is compared with similar medical institutions – of the same type and approximately the same size. Because high costs in themselves do not mean a problem. The problem appears when the costs deviate very seriously from those of similar hospitals and there is no apparent explanation.
For 2025, the platform has marked deviations worth a total of about 606 million leva. This does not mean that this money was necessarily spent illegally, diverted or the subject of some commercial gymnastics. It means that there are deviations serious enough to ask questions and conduct checks.
- What are the most striking differences that you found in the prices of the same medications purchased from different medical institutions? What do you think are the reasons for these differences?
- One example is a medicine that in one hospital was reported at a price of nearly 900 leva, and in another - about 69 leva. We are talking about the same medicinal product and the same packaging. The difference is more than 12 times. And no, there is no argument here that in one place they must have ordered many units, and in the other one or two. The orders in their volumes are also visible and exactly comparable - the real deviations are in the price.
For another product, one state hospital paid about 35 thousand leva per unit, while other state hospitals bought it for about 20 thousand or even for under 17 thousand leva. When delivering 60 units, the accumulated difference is already measured in a very large amount.
I cannot automatically say that every such difference is abuse. There may be different conditions under the contracts, delivery terms, quantities, discounts, specific therapeutic circumstances or method of reporting. But when the difference is 20 or 30 percent, one can look for an explanation. When it is 12 times, the explanation must be very clear and public. And lead to changes. The platform itself cannot establish guilt. It can show where the question should be asked. Society must insist on answers.
- What are the main conclusions that can be drawn about the way public funds are spent in hospital healthcare?
- The first conclusion is that there are huge differences in the system between similar medical institutions. This is seen not only in medicines, but also in consumables, maintenance, external services and public procurement.
For example, there are hospitals whose costs for medical consumables are over 500% higher than the average for their group, as well as cases of maintenance costs that are over 150% higher than those of similar medical institutions.
The second conclusion is that the lack of sufficient competition in public procurement can be a serious risk. When there is only one candidate, there is no real market pressure on price.
The third is that costs do not always show a clear relationship with the quality of treatment or the conditions for medical specialists. In places we see increasing costs for external services, while the salaries of nurses and young doctors remain low.
And perhaps the most significant conclusion is that until now citizens have had almost no opportunity to see all these indicators in one place. Including institutions.
- What sources did you use when building the platform? Was the information collected through applications under the Access to Public Information Act, through public registers of public procurement, official institutions or through already published media investigations?
- The basis of the platform is official public data. We used financial reports and information from the Ministry of Health, data from the NHIF on payments to medical institutions, medicines and clinical pathways, the Centralized Automated Information System for Public Procurement, the National Health Information System and other official registers.
Information obtained under the Access to Public Information Act was also used.
Media investigations can be a starting point and show where there is a public issue, but the analyses in the platform are not based on media claims. They must be traceable to an official document or database. This is important because the platform should not depend on anyone's interpretation, including mine. Everyone should be able to get to the primary source.
- How difficult was it to collect and process this information? Did you encounter institutional obstacles or refusals to obtain data?
- The difficulty is not only finding the information. The difficulty is to put it in a form in which different sources can be compared. It took me about 8 months, maybe a little more, to get informed, collect data and design the platform.
One institution publishes an Excel file, another - PDF, a third has an online register, a fourth uses different names for the same things. Sometimes the same medicinal product is recorded in different ways. Hospitals are also not exactly the same, so you can't just put them in a table and say which one spends more.
The big job was cleaning, linking, and validating the data. We're talking about millions of individual records.
Rather, the main institutional obstacle is that the information was not created with the idea of being easily analyzed by citizens. It is formally public, but is often technically difficult to access. I would not say that every institution is intentionally hiding something. The problem is that there is no common updated standard and a unified environment in which the data can be easily checked and compared. And this is also important for the management decisions in the state itself, which, for me, should always be made on the basis of real data, not on instinct and thrown beans. Or with another intention that takes into account the data, but denies them.
- Do we have a systemic problem in public procurement of medicines or are we talking about individual cases of ineffective management?
- When the same types of deviations appear in different hospitals and in different categories of expenses, there is already reason to talk about systemic risk. This does not mean that each specific order is illegal. It means that the rules and controls allow for too large differences to occur, without the public receiving a timely explanation.
The problem may be the lack of competition, the way in which orders are prepared, the different ability of hospitals to negotiate prices, the annexes to contracts or insufficient follow-up control.
That is exactly why individual cases must be checked. The platform can point out a repeatable pattern, but the institutions have the authority to establish the cause.
- How can the platform be expanded - for example, by tracking the costs of medical devices, consumables, equipment or other items in the health system?
- This is the natural next step. Medicines are only one part of the costs. Huge amounts of money are spent on medical devices, implants, consumables, laboratory activities, equipment, repairs, maintenance and external services.
It is particularly important to be able to track not only the purchase price, but also the entire life cycle of an expense. For example, how much a piece of equipment costs, how much it is used, how much it costs to maintain it and whether a nearby hospital already has the same equipment that is under-utilized. We want to add more context, because a deviation does not always mean a problem. The more official data there is on the activity, patients, the specifics of the treatment and contracts, the more accurate the analysis will be.
That is why the conversation with the Ministry of Health, the National Health Insurance Fund and the “Information Service” is important. If institutions provide the data in a structured and machine-readable form, the platform can become not only a civic tool, but also a real system for early detection of risks.
- Can such civic initiatives really lead to more transparency and more effective control over spending on health?
- They can help, but they cannot replace the state. A civic platform can collect information, make it understandable and show where there are unusual values. It can make people, the media and institutions ask questions. But it does not have the authority to carry out inspections, require contracts or impose sanctions.
“Black Track“ does not systematically solve the problem of accidents. It showed its real scale and made it more difficult to present it as a series of random incidents. Then institutional maps and tools appeared. I hope that all subsequent actions will be provoked by the understanding of the problems and the need to preserve the lives of people on the roads.
I hope the same will happen with “Diagnoza Bulgaria“. The best result will not be that the platform remains the only such tool. The best result will be that the institutions themselves start publishing, comparing and checking this data. For me, transparency is not the publication of thousands of files that no one can read. Transparency exists when a person can understand where their money goes and when an unusual expense receives a timely and specific explanation.