NFZ without money. The government has a problem...

The report "The financing gap of the health care system in Poland - the 2025-2027 perspective," which was presented on Tuesday, includes several variants showing the scale of the necessary financing of the system - depending on the spending assumptions adopted. Importantly, all of the data are derived from the Long-Term State Financial Plan for 2024-2027, current GDP growth forecasts and the NFZ revenue forecast for the next three years, adopted by the Minister of Health and the Minister of Finance.

At a minimum, said Bernard Wasko, MD, director of NIZP PZH-PIB, former vice-president of the National Health Service, a purely arithmetical variant (because there will be no political approval for it), which assumes a reduction in the payer's obligations (including withholding funding for over-limit services or no funding for new medical technologies), the financial gap will be no less than:

22 billion in 2025,

29.5 billion in 2026,

41 billion in 2027,

Which brings the total to 92.5 billion zlotys that will need to be directed to the National Health Fund between 2025 and 2027.

Maintaining (the framework, as the authors of the report emphasize that some savings will also be necessary in the baseline scenario) the current level of efficiency of the health care system the gap is

31 billion in 2025,

41.5 billion in 2026,

57 billion in 2027,

Which brings the total to PLN 129.5 billion.

However, there are two more costly solutions on the table: the amendment to the law on minimum wages, or the so-called "nursing project" (in fact, the Health Ministry's proposal, which is half as expensive as the baseline) - PLN 15 billion over three years, and the proposal to reduce the premium for entrepreneurs - another PLN 15 billion. The financial gap in the extreme variant (assuming that the chances of the Sejm passing the minimum wage amendment in the version the nurses are fighting for is impossible, that is, assuming the baseline scenario and acceptance of these two solutions, would reach PLN 160 billion.

- This is a corpse from the closet, hidden by predecessors," Slawomir Dudek, an expert from the Institute of Public Finance, said on Tuesday. The authors of the report point out that the destabilization of the health care financing system was, in a way, sewn into the law of 6 (and later 7) percent of GDP for health, because when the law was passed, it was assumed that at some point the state budget would have to start contributing large sums to the system to implement the roadmap - but for a good few years this turned out to be unnecessary. The reasons? First, the dynamic rebound of the economy and the growth of the labor force (health premiums skyrocketed), then - the pandemic and the large budget commitment to finance covid benefits. The reduction in other hospital activities generated large reserves in the reserve fund (at the end of 2022 it was about 22 billion zlotys), which was emptied, virtually to the end, in 2023. And that was the year we spent more than 7 percent of GDP on health - according to the statutory n-2 methodology. This level of spending allowed us to fund all tasks, but it is unsustainable - without analogous additional money, while the cost of the system is growing all the time.

The report's authors stopped at seven recommendations, four of which explicitly refer to the Minimum Wages Act, for which even the increase in revenue from health premiums (PLN 15 billion vs. PLN 12 billion) is insufficient at the moment. They hint to policymakers that it needs to be renegotiated, if only because health outlays are growing according to the n-2 methodology, while the base amount in the Minimum Wages Law is n-1 (the average salary in the economy for the previous year).