Funding for healthcare in recent months has been one of the most important topics of public debate. Difficulties in fulfilling obligations by the National Health Fund (NFZ) in the coming quarters and the lack of acceptance for the Fund’s financial plan for 2025 have significantly increased public interest in healthcare.
Difficulties in ensuring continuity of funding for services have been anticipated for at least several months. The biggest impact on the emergence of problems has been the accumulation of obligations beyond the revenue capabilities of the National Health Fund. The implementation of the Act on the profession of doctor and dentist in 2022, which burdened the NHF with the costs of tasks previously financed from the state budget, and the manner of implementing the Act on the method of determining the minimum basic salary for certain employees in healthcare institutions [hereinafter: “the Act on minimum salaries”] in 2023-2024 resulted in the Fund using all financial reserves accumulated during the COVID-19 pandemic, and in the near future, there are no expected conditions to restore them.
The National Health Fund has permanently lost the ability to settle its obligations under the previous terms. The complete use of the reserve fund and the related liquidity crisis have led to a situation where the public payer cannot continuously finance all undisputed obligations. It is also forced to implement necessary adaptive measures, changing the funding principles for services observed in recent years. A long-term consequence of the current situation, stemming from the lack of reform in the contribution system and commitments stipulated in the Act on minimum health care spending, is the loss of the self-financing nature of the system. The insurance system, largely financed by health insurance contributions, is being replaced by a mixed contribution-budgetary system. For the first time since the implementation of universal health insurance in Poland, healthcare will have to compete for limited funds from the state budget, which is particularly concerning given the state of the entire public finance sector.
At the same time, no decisions have been made in recent months that could counteract the diagnosed problems. Firstly, cost pressures on the National Health Fund, which is legally obliged to finance tasks for which it has no secured funds, have not been limited. Secondly, new obligations are being incurred that burden the payer without securing funding sources. Thirdly, the Sejm is working on regulations that will result in reduced revenues for the National Health Fund from contributions, further linking the financing of healthcare services to the shape of the budgetary law.
The aim of this document is to present to the public the current values concerning the amount of funds available to the National Health Fund and the Ministry of Health, which are necessary to ensure the continuity of funding for the healthcare system in Poland. The authors of the document also point out the significant context – the implementation of excessive deficit procedure against Poland by the European Commission and the decision regarding including healthcare spending within the framework of the Stabilizing Expenditure Rule (SER), which will have extensive consequences for budgeting in healthcare.
See also the report The financing gap in the health care system in Poland”
