A big hole in the budget of the National Health Fund. 23 billion zlotys will be missing

Experts from the Federation of Polish Entrepreneurs estimate that a conservative estimate of the NFZ's spending needs for 2026 under the current state of the law is about PLN 240 billion. Meanwhile, the Fund's financial plan provides for revenues of PLN 217 billion - so the difference will be at least PLN 23 billion. The authors of a cyclically published study on health care finances estimate that the health budget is constructed at the level of the minimum plan, i.e. it meets the statutory threshold of 6.8 percent of GDP for health (according to the n-2 rule), which must be achieved next year. This plan (like this year's plan) does not take into account the actual cost dynamics of the system. Combined with the practical zeroing of the reserve fund (this year it will amount to about PLN 2 billion), this means growing problems with the payer's liquidity, especially as the value of the Fund's unpaid so-called "surplus" services, including in non-limited benefits (about PLN 6.3 billion), which the NHF will have to cover from next year's budget, is growing rapidly.

According to the draft financial plan presented, the planned total costs of the NFZ in 2026 are expected to be PLN 217.4 billion, the lion's share of which is revenue from health premiums (PLN 184.3 billion), supplemented by funds from pro-health fees (PLN 1.8 billion), transfers from earmarked funds (PLN 2.6 billion) and - above all - a subject subsidy from the state budget (PLN 26 billion). At the same time, the planned subsidy for next year is lower than what the state budget has transferred to the Fund so far this year.

Experts note that between 2016 and 2024, the number of total health care services provided under the National Health Service increased by 9.8 percent, while the cost of providing them in nominal terms increased by 160.3 percent. The increase in costs adjusted for inflation was 64.4 percent, while adjusted for nominal GDP growth reached 25.2 percent.

The largest increase in the number of services performed - by as much as 119.1 percent. - occurred in the case of palliative care, with a 356.8 percent increase in funding for this area (in nominal terms). In contrast, the smallest increase in funding and also the largest decrease in the number of services performed occurred in the area of dentistry. In the case of outpatient specialty care, despite an increase in funding by as much as 208.7 percent (in nominal terms), the number of services performed increased by 6 percent. Difficulties in access to specialty care are one of the most frequently cited problems in the Polish health care system, despite the fact that AOS services have been unlimited for several years.

The authors of the analysis point out that the cost of health services is growing dramatically faster than the level of inflation. They point out that while the unit cost of a single service in the National Health Fund has grown by 137 percent over the past nine years, the level of consumer prices has risen by 52.1 percent. One of the factors behind such a high rate of cost growth in health care is the amendment to the law on the method of determining the lowest basic salary in health care, effective from 2022.