Patients must take into account the longer queues

Medexpress: What do the assumptions for the changes in health financing regulations, published on September 30, mean?

Dr. Tadeusz Jędrzejczyk: It is, simply put, shifting the burden of financing tasks from the state budget directly to the budget of the National Health Fund. Also those that the NHF has financed so far only as an intermediary, because it received money for this purpose from the state budget. In other words, it means, first of all, receiving a subsidy from the state budget to the payer's budget. It is also worth noting that the state budget is to stop transferring money to the National Health Fund for the premium compensation for the uninsured. The state budget wants to save on the Fund's expenses, that is - de facto - on health. The logical consequence will be that the National Health Fund itself will also have to look for savings. Certainly, it will not find them in administrative expenses, because for this purpose it allocates 1 percent. your budget. So he has to look for savings in benefits expenses.

M: Maybe the government predicts that in the NHF budget there will be - again - a "pile" of money, difficult to manage? That the health insurance premium will grow fast enough, if only due to inflation?

TJ: It's hard to rule out this kind of thinking, but it's worth remembering that there are many variables here. Wages due to inflation may indeed grow faster, but it is by no means saying that unemployment will not rise at the same time. And the contribution volume depends on these two factors, i.e. wages and the number of people working, not only on how fast wages are growing. There is no doubt that the economy, driven by domestic consumption for years, may experience a strong cooling down. In addition, as it seems, the driving force associated with the wave of refugees and their purchasing power is also dying out - not only thanks to benefits, but also to work undertaken in Poland. It is clear that these growth drivers are weakening. You have to be extremely cautious in estimating the revenues of the National Health Fund for 2023, because it may turn out that despite high inflation there will not be any money at all.

Looking from the budget perspective, the transfer of health expenditure to the National Health Fund seems to be rational - the Fund is in good shape, it has a reserve fund, and if there are perturbations, it may even take out a loan with the consent of the government. The trouble will be transferred to another term.

M: What will the consequences of these decisions be?

TJ: The most obvious effect seems to be a cooling down of the employee market in the public system. So far, we have dealt with a fairly high dynamics of departing from the public to the private system, but it seems that this phenomenon will weaken - medical services become more expensive and noticeably the demand for them will decrease. Working in the public system may again - as it was during the 2009-2011 financial crisis - turn out to be not so lucrative, but stable. In addition, nominal wages will increase, although not as expected by employees. Perhaps the next rate hikes will be significantly below the inflation rate.

Patients must take into account the limited availability of services, and longer queues. It is obvious. In turn, service providers will go into debt. Anyway, it is already visible that the liabilities of hospitals have increased significantly, well above the inflation level. Also, very well-managed hospitals, which will use funds sparingly, keep the payroll fund in check, will find it difficult to look for savings on expenses for utilities or external services.