In Poland, public healthcare is primarily funded by a single, central payer—the National Health Fund (NFZ). All health insurance contributions are allocated to this institution, which finances hospitals, clinics, and pharmaceutical programs. In practice, this means that any deficit in the NFZ immediately impacts patient access to treatment, as the system lacks alternative payers or parallel stabilization mechanisms. This model only works as long as the flow of funds is sufficient to cover rising costs. According to official data, the NFZ budget is expected to be short by approximately PLN 14 billion in 2025, and revenues from health insurance contributions are also PLN 3.5 billion lower than expected. Projections are even more alarming: in 2026, the gap could reach a minimum of PLN 23 billion. However, the most dramatic forecasts concern 2028, when the budget gap could reach PLN 90 billion, an amount completely unattainable under the current financing model. Rising medical costs, rapidly increasing therapy prices, undervalued hospital contracts, and wage pressures are preventing the central payer from keeping pace with these expenses. Poland is also experiencing so-called medical inflation, a phenomenon in which the costs of technologies, medications, and procedures rise faster than the general inflation rate. This means that the NFZ pays more each year, but receives less in real terms.

Planned spending cuts will directly affect the availability of services, resulting in increased wait times for specialists, reduced diagnostic test availability, limited access to drug programs, and a higher likelihood of hospital procedure postponements. Many facilities are already reporting that NFZ reimbursements do not cover the actual costs of treatment, forcing them to limit the services they can offer. In a single-payer system, budgetary inefficiency is not an abstract concept; it translates into real delays in treatment and a dramatic decline in the quality of services. Public debate has been characterized by attempts to shift the blame onto foreigners, especially Ukrainians, but NFZ data contradict this: their contributions actually exceed the costs of treatment. The crisis is not migration-related, but structural. Poland is facing the same trends as other European countries – an aging population, rising drug prices, and global supply chain risks – but its central financing model means that any revenue fluctuation immediately paralyzes the entire system.

Therefore, what is needed is not a set of ad hoc adjustments, but a change in operational philosophy. The current crisis demonstrates that the monopolistic payer model has reached its limits. A rational solution would be to introduce universal health insurance with a choice of insurers, and to create a reinsurance fund to protect the system against the bankruptcy of any insurer. Competition, not monopoly, drives cost-effectiveness. A realistic benefits package, based on cost calculations rather than political promises, would avoid bottlenecks resulting from the fiction of “everything for everyone.” Restoring balance also requires the gradual liberalization of medical infrastructure, transferring clinics and hospitals to employees, foundations, local governments, and companies to increase management efficiency. Only by abandoning the central monopoly, initiating competitive mechanisms, and defining a realistic scope of services, can the growing deficit be halted and patients regain real access to healthcare. Otherwise, the funding gap will grow, waiting lists will lengthen, and the increasingly overloaded system will head toward complete collapse.

Source, Łukasz Wojdyga

Director of the Center for Strategic

Studies Warsaw Enterprise Institute