Health finance in crisis. Huge gap

Wednesday saw the publication of the report "Health Care Finances Under Close Scrutiny of the Excessive Deficit Procedure," prepared by experts from the Institute of Public Finance and the Federation of Polish Entrepreneurs. It shows that the difference between the NFZ's revenues from premiums and the expenditures necessary to maintain benefits at the current level, taking into account the decisions to be taken (such as reducing the premium burden for entrepreneurs) in 2025-2028 will reach PLN 249 billion. And even if this is the maximum amount - the baseline scenario says PLN 216 billion - there is no doubt that subsidies from the state budget will have to grow at an express pace if politicians decide not to make any significant changes to health care financing.

Although 2024 has already brought huge problems - especially in the second half of the year, there were problems with the availability of new patients for drug programs, and the median waiting time for visits to specialists also lengthened - this may be just a prelude to what will happen this year and next. As Wojciech Wisniewski (FPP), co-author of the report, said during the discussion accompanying the presentation of the report, further deterioration of access to services and increasing payment bottlenecks on the part of hospitals must be expected. - Patients and entrepreneurs, primarily Polish companies, will suffer, he warned. According to him, there may be an increase in waiting times for elective procedures, but worse availability for surgeries or tests ordered as urgent is also possible. The situation will not be saved by the private sector, which is shallow in Poland, Wiśniewski said, and provides mainly less costly treatments, while the group of patients who can afford private treatment - even only to a certain level - is not large.

The report, published on February 19, is a kind of update of the one that experts presented in June. At the time, said Slawomir Dudek, an economist at the Institute of Public Finance, "it seemed that the wall for the NFZ's finances was approaching us by rapid steps, but we thought we still had a while to go." - However, the 2024 execution shows that this wall is millimeters ahead of us. Last year, the NFZ's financing gap topped PLN 30 billion. Two-thirds of the gap was financed by cuts to other health expenditures at the health ministry, an increase in the budget deficit, and a hidden subsidy in the form of bonds that was not shown in the budget deficit. One-third will be covered by the NHF's reserve fund. Unfortunately, this cushion is no longer there for 2025 and beyond. The gap will grow and all of it will have to be covered by the state budget. In the next three years, up to one-third of the NFZ's expenses will be financed by subsidies from the state budget," he calculated.