The health care system in 2025-2027 requires funding of between PLN 92.5 billion and PLN 158.9 billion, the authors of the report “The financing gap in the health care system in Poland” alert. Decisions made in the past two years have led to the almost complete liquidation of the National Health Fund’s financial reserves, and liabilities resulting primarily from health care wage increases have a lasting and growing impact.
During the inaugural conference of the report “The financing gap in the health care system in Poland – the 2025-2027 perspective”, a total of several variants were presented, showing the required scale of financing of the health care system in 2025-2027. The data on which the authors of the publication relied came from official government sources, including the Long-Term State Financial Plan for 2024-2027, current GDP growth forecasts, and the revenue forecast of the Polish National Health Fund for the next three years adopted by the Minister of Health and the Minister of Finance.
In the coming years, the annual deficit in the Polish National Health Fund, in the extreme scenario, will be in the range of PLN 40-68 billion, or 1-1.5% of GDP. This is another wolf’s trap that Prime Minister Morawiecki’s government has left behind for its successors. It is also a warning signal. All the more so because part of the political scene is proposing a deep cut in the health premium, which will further enlarge this hole in the Polish National Health Fund, argues PhD Slawomir Dudek, president and chief economist at the Institute of Public Finance.
Minimum scenario and baseline scenario
According to the minimum scenario, which assumes a reduction in liabilities arising on the part of the public payer in the form of withholding funding for over-limit services (the so-called “over-performance” in limited ranges), lack of funding for new medical technologies and updating of valuations in the most priority areas, the financial gap will amount to no less than:
- PLN 22 billion in 2025,
- PLN 29.5 billion in 2026,
- PLN 41 billion in 2027,
making a total of PLN 92.5 billion that will have to be directed to the Polish National Health Fund in 2025-2027.
According to the baseline scenario, to maintain the current level of efficiency of the health care system in Poland, the subsidy in 2025-2027 should amount to, respectively:
- PLN 31 billion in 2025,
- 5 billion PLN in 2026,
- PLN 57 billion in 2027,
making a total of PLN 129.5 billion.
The minimum scenario is, in practice, the freezing of tariffs for new services for 3 years, the lack of reimbursement for new medicines or health policy programs, growing queues, or, finally, a significant increase in the debt of hospitals,” points out Bernard Wasko, Director of the National Institute of Public Health.
The size of the funding gap will also depend on current decisions. If the Sejm adopts the Health Ministry’s proposal related to the civic bill on the way to determine the lowest basic salaries of some employees working in medical entities, each of the above sums should be increased by an additional PLN 14.4 billion, and, assuming additional introduction of changes in health premiums, by another PLN 29 billion. In such a scenario, even the allocation of an additional PLN 121.9 billion from the state budget to the Polish National Health Fund in 2025-2027 will not allow to maintain the current level of efficiency of the health care system in Poland. In turn, to increase access to services or improve their quality (e.g., shorter queues to specialists, and better access to modern medical technologies), the state budget will have to direct at least PLN 158.9 billion to the Polish National Health Fund over the next 3 years.
In addition, the coming years will bring an unfavorable transformation of the healthcare financing system from one based mostly on revenues from contributions to one based on mixed contribution-budget financing.
The share of budget outlays (subsidies) in total healthcare expenditures will increase several times. In the extreme scenario, more than 1/3 of the Polish National Health Fund’s expenditures will be financed by subsidies coming from the state budget. This means a contribution capacity of the Polish National Health Fund of less than 67%, while the current capacity of the Social Security pension system is more than 85%. This means that the relative deficit in the Polish National Health Fund (the scale of non-coverage of expenditures by contributions) will be more than double that of the FUS (Social Insurance Fund) managed by the Social Insurance Institution, about 33% vs. 15%. It turns out that the “mythical hole in Social Insurance Institution” is not the only problem of public finances. A serious competitor has sprung up, the health care system, which will expand its financial hole with momentum, Slawomir Dudek warns.
PhD Dudek points out that a mixed system is in addition unpredictable and less stable. It also reduces the autonomy of the health care system. Subsidies depend on the country’s current budget situation, and on whether the country is, for example, in an excessive deficit procedure or not.
It is important to keep in mind that money for subsidies from the budget does not grow on the tree, it is finically covered by other taxes. We have the illusion that the supposedly generous state is adding to the system, that the contribution is supposedly lower – as they promised, but after all, in the end, the taxpayer finances everything anyway. In a mixed system, we have a distorted transparency and coherence of the system and a lack of awareness that it is the taxpayers who finance the health care system. A system based entirely on contributions is, in a sense, a tool for self-education and self-regulation, which reinforces its stability. The average taxpayer sees a direct link between premiums and spending in the system. If this link is unclear, public awareness and accountability decreases, the IFP’s president explains.
Higher premiums only finance wage increases
The report’s authors also point to the reasons for the Polish National Health Fund’s poor financial situation. In 2023. The Polish National Health Fund used up almost all of the reserves that accumulated during the 2020-2022 pandemic. This was led, among other things, by the introduction of an amendment to the Law on the Profession of Physician and Dentist in November 2022, which shifted the burden of financing many tasks from the state budget to the Polish National Health Fund. In addition, the cost of implementing the amended 2022 law on how to determine the minimum basic salary of certain employees working in medical entities.
As a result of these changes, there has been a sharp increase in the spending needs of the Polish National Health Fund, which far exceeds the increase in revenue from the health insurance premium. This means that all the additional funds from the increased health insurance premiums paid by citizens are being used for increased salaries of medical personnel.
In the November 2021 position paper of the Trilateral Health Care Team, the government, employers, and unions agreed that half of the increase in healthcare spending should go to improving salaries and the rest to increasing the availability of services and new technologies. Several years later, we are in a situation where patients do not feel any improvement in access to health care despite directing additional funds to the system, adds Wojciech Wisniewski, a member of the Trilateral Team for Health Care on behalf of the Federation of Polish Entrepreneurs.
In the extreme scenario, more than one-third of the Polish National Health Fund’s expenses will be financed by a subsidy from the state budget. This compares with about 15% for Social Insurance Institution. According to experts’ estimates, the share of budget outlays in total healthcare spending in 2027 will surpass, among other things, spending on the 800+ program. Health care, which until recently was a source of relatively small liabilities on the side of the state budget, will become, next to the social security system and defense, one of the three areas with the largest impact on state spending.
The system has gone awry for us. Wages have been heavily rigidized, their dynamics are not linked to either contributions or GDP. On the one hand, we have premiums that grow like the wage fund in the economy, on the other we have the relationship to nominal GDP, and on the third we have spending pushed up by the minimum wage in health rigidly tied to average wages. It’s like three steering wheels in one ambulance. We won’t get anywhere that way. This system is sick. In the long term, the NFZ’s hole could grow to as much as 2% of GDP per year, PhD Dudek stresses.
Recommendations for change
What can be done to avoid total financial collapse of the health care system
in Poland? In the compiled report, the experts presented recommendations with the
with justification for each of them:
- Introduce regulations that allow unused funds to be directed from the Medical Fund to the Polish National Health Fund to finance health care services.
- Seeking solutions to reduce the subsidy portion towards a self-financing system.
- Introducing solutions that allow contractual salary increases to be disregarded in the tariffing of health care services when the salary level of a given employee exceeds a certain multiple of the average salary in the economy.
- Suspension of work on the civic bill on the method of determining the minimum basic salary of certain employees working in medical entities in the part that will increase liabilities on the part of the Polish National Health Fund.
- Amend the law on the method of determining the minimum basic salary of certain employees employed in medical entities by:
- amending the law so that the statutorily guaranteed minimum wages go into effect on January 1 instead of July 1;
- replacing the base amount of the average monthly gross salary in the national economy with another base rate developed in cooperation with the social partners, indexed in a similar way to pension and disability benefits.
- Ensure a balanced distribution of incremental resources for salaries and investments in new technologies and the availability of benefits.
- Verifying the requirements for minimum staff resources for health care providers specified in the basket of guaranteed benefits by analyzing the possibility of expanding the competencies of different groups of medical personnel.
The financing gap in the healthcare system in Poland
The authors of the study, entitled. “Financial Gap in the Health Care System in Poland – Perspective 2025-2027” are Bernard Wasko (National Institute of Public Health – National Institute of Hygiene), Slawomir Dudek (Institute of Public Finance), Wojciech Wisniewski (Federation of Polish Entrepreneurs) and Lukasz Kozlowski (Federation of Polish Entrepreneurs).
