This study analyses the financial performance of Bulgarian public and private multi-profile acute care hospitals and benchmark hospitals. This study employs financial ratio analysis, a mathematical optimization model, and supporting statistical analysis. All hospitals for which information has been published were included. The ratios for return on assets, net cash flow per bed, operating margin, and total assets turnover were calculated based on 2023 financial statement data and used to benchmark the medical institutions. The findings indicate that private hospitals operate with a profit motive, are nearly twice as efficient in generating sales revenue from their total assets, and are approximately 15 times more efficient in generating cash flow from their capacity (per bed). Less volatile than private hospitals, state-owned hospitals rely on subsidies or external funding to cover their operating costs. This study has important implications for government and multi-profile acute care hospital management. This study contributes to the literature by providing an optimization-based financial benchmark for Bulgarian hospitals, demonstrating that real-world data can be used to identify critical institutional anomalies.