Priority: money

Shouldn't the Minister of Health talk about how the health care system is short of money? On the contrary - she should mainly talk about it. Because in fact, the scale of underfunding is much higher, and it is primarily (though not exclusively) generating problems and tensions in the system, including tensions over salaries. Politicians don't want to talk about it or hear about it (hence Prime Minister Donald Tusk's assurances that the government won't raise the health premium sound frighteningly predictable), so the information that the head of the health ministry and representatives of the National Health Service are providing is a "minimum sentence": so many billions are missing to keep it the way it is. To maintain the current level of accessibility to services. To be able, to use a concrete example, to consolidate, restructure facilities by planned extinction or reduction of work of acute wards, and not to be surprised by unplanned, bottom-up, even wild "restructuring", resulting from the need to liquidate and close wards for the operation of which there is not enough money. This is, of course, a drawing of the future with a thick line, but certainly not a surreal one.

No matter how ambitious the health ministry's plans for digitization, medical staffing or drug policy, everything comes crashing down on money, or rather the lack of it. Jolanta Sobieranska-Grenda straightforwardly admitted that the primary challenge is to ensure the payer's financial equilibrium, which, as NFZ Vice President Jakub Szulc complemented, was lost in 2023. This is an extremely difficult task, which will require cost cuts (the law on minimum wages for health care workers) and at least a perceptible, if not significant, increase in revenue. An amendment to the increase law seems impossible, but the ministry promises to hold talks and seek a compromise. It also makes no secret of the fact that the finance ministry is involved, seeing the law as the main cause of the health finance splurge. Even if it's clear that the main cause remains the underfunding of health care, it's hard to deny that the dynamics of the increase in spending on salaries plays a significant role in this destabilization of the NFZ budget.

Is a compromise possible? It seems that a bargaining chip could be the introduction of maximum salary ceilings. The issue is, of course, doctors' salaries - no other professional group has such a strong card in salary negotiations, so it can be presumed that the salary cap will also cover - in one form or another - contractual agreements. Such a proposal is bound to come up, if not from the Ministry of Health, then representatives of trade unions (and employer organizations) certainly will. What do the trade unions and the medical self-government say about it? The reaction is also predictable and the field of compromise - difficult to see without using precise optical tools. - There is a strong expectation from the social side," Deputy Minister Katarzyna Kęcka said during a meeting with journalists, referring to the demand for the introduction of maximum salary ceilings. However, it seems that there will also be equally strong resistance on this issue.