Expert ways to narrow NFZ gap

The list of proposals includes raising the health premium, charging not only the insured, but also the employer (Poland is, as the report's authors point out, the only European country with an insurance system in which the employer does not pay any health premium for its employees), but also increasing the raking power of "sin taxes," including excise taxes on alcohol and cigarettes or... raising the retirement age.

Experts from the Warsaw School of Economics estimate that the projected funding gap in the National Health Service between 2025 and 2027 will be PLN 111 billion. This is a huge amount, in addition, health has to compete more and more strongly for budget funds with, for example, defense spending. The availability of services is deteriorating, which is the result of the leanness of public spending on the one hand (according to an OECD report, it is indeed less than 5 percent of GDP) and on the other, an aging population and a higher burden of civilization diseases in younger age groups. - Today, health premiums are based on earnings. They are paid by 70% of the population. The group of seniors will grow, which will reduce health premium revenues," said Prof. Monika Raulinajtys-Grzybek during Monday's presentation of the report, which includes recommendations for changes.

A large group of solutions concerns the rules for paying health premiums. - We are proposing to increase the contribution rate for employees, pensioners by 0.25 p.p. per year for the next four years, up to 10%, increase the contribution rate for the self-employed nominally corresponding to the increase in the contribution rate for employees, and force changes in preferential health insurance coverage for farmers. These changes are expected to result in the inflow of an additional 37 billion zlotys, and this is 33 percent of the value of the gap, explained Prof. Barbara Więckowska, a professor at the Warsaw School of Economics and head of the Department of Innovation in Health Care at the Warsaw School of Economics.

If the health contribution from employers (2.5 percent) were added to this, revenues would increase by another 42 billion zlotys (38 percent of the gap value) over three years.

The introduction of a state-funded health insurance premium for children at 4.5 percent of the minimum wage would cover 42 percent of the projected gap.

Another source of revenue could be subsidies for services or private health insurance. - PLN 10 to a visit, whether it is an outpatient consultation in POZ or AOS, and PLN 50 for a hospital stay. These amounts could inject PLN 6.3 billion into the system. Private health insurance of PLN 50 per month would be a small additional premium compared to private insurance offered on the market, but with such a large population, when risks are spread, the quality and availability of services can be increased for this small amount. The gap projected for 2025-2027 would be covered by this insurance with an amount of PLN 6 billion, the expert calculated.

Artur Bialoszewski, an expert from the OIL in Warsaw, discussed the possibilities related to the so-called sin tax, or "sin taxes." At the moment it's an excise tax on alcohol and tobacco, and a sugar tax. A fat tax (on fast food) should also be considered, according to the expert.

Some of the experts' recommendations should not cause any controversy, moreover - these were solutions advocated by those currently in power in the previous term, this primarily concerns the return of funding for medical rescue to the state budget. - Medical rescue should be financed in the same way as the fire department, the army or the police, because these are elements of citizen security," Bialoszewski said.

There are also very controversial solutions on the list, such as changing (raising) the retirement age. - Extending and equalizing the retirement age from the point of view of the health system is essential, because this will increase funding sources. People will be active in the labor force longer and pay contributions for longer. Increasing labor force participation benefits the health of the population, the expert explained.