Healthcare financing is not an accounting game

For a week now, health protection experts, especially system financing, have been wondering about the reasons why the government decided to withdraw the budget from financing health services and the consequences of this decision. It is known that it was not consulted with the National Health Fund Council, neither patient organizations knew anything about it, not to mention social partners, for example, from the Social Dialogue Council.

- The aim of the draft amendment to the act on the profession of doctor and dentist is to actually change the provisions of the 7% regulation. GDP for health. Depletion of funds at the disposal of the National Health Fund within three years from PLN 21.4 billion to PLN 37.4 billion. The probable scenario indicates the amount of about PLN 27.4 billion - said Wojciech Wiśniewski on Friday during the webinar. The expert emphasized that this decision should be read in conjunction with the Act on minimum wages in health care, which significantly (for the finances of the system) increases the personnel costs of service providers. In his opinion, this means that in practice the entire increase in public expenditure on health care will be used to increase salaries and additional burden on the National Health Fund, which will not allow increasing the availability of healthcare services and ensuring access to further effective and safe medical technologies. Wiśniewski recalled that in the fall of 2021, the Ministry of Health promised to distribute funds obtained thanks to the increase in financing of health care - half was to be spent on increasing salaries, and half - on improving the availability of services and new technologies. Now it turns out that in practice all the increase in financing will be eaten up by the increases - and this turns out to be insufficient.

The reason is obvious - the increase in health care financing occurs only on paper. According to data from the Central Statistical Office of Poland, in 2021 public current expenditure amounted to 4.9 percent. GDP (very far from 6%, which according to decision-makers we have already achieved or even exceeded).

Now the government is proposing to transfer the financing of preventive vaccinations, emergency medical services, medicines for seniors and pregnant women, the hemophilia and HIV/AIDS treatment program and highly specialized procedures to the NHF budget. This means an increase in the payer's burden of up to several billion zlotys a year. - The money for patients for the services financed so far will actually be less.

Moreover, the government provides for the possibility of a one-time transfer of funds from the National Health Fund's reserve fund to the COVID-19 Counteracting Fund, to be used for tasks related to health protection. But, as the expert emphasized, it will take place completely outside the control of the Sejm. - The government is therefore planning to transfer funds from citizens paying health insurance contributions to the COVID-19 Counteracting Fund, which is not subject to public control by the public and the Sejm. Moreover, the criteria by which these funds can be spent remain unclear.

- Healthcare financing is not an accounting game. The introduction of regulations on the minimum level of public expenditure on health protection was to guarantee that the institutions creating the system will have more funds than it results from the country's economic growth - the expert recalled, emphasizing that the mere presentation of such a proposal violates social contracts from recent years, including an agreement signed in 2018 by the then Minister of Health, Łukasz Szumowski, with the Agreement of HMPA Residents.