The National Health Fund (NFZ) plays a fundamental role in the Polish healthcare system, fulfilling a key role in the organization and financing of medical services. Its main responsibilities include contracting services and distributing funds to healthcare providers. This system is intended to guarantee equal access to medical services and ensure financial stability for hospitals, clinics, and other healthcare facilities. This is crucial for their effective operation. In theory, this mechanism should create a coherent and sustainable ecosystem in which patient needs are met and healthcare providers can carry out their tasks without worrying about financial liquidity.
However, the reality proves much more complex and far from the intended goals. Medical facilities in Poland face numerous barriers that hinder their mission to promote public health.
The NFZ’s healthcare financing system, despite its intended purpose, does not fully meet expectations in terms of stability and efficiency. Delays in payments, especially for services performed above the limit, the lack of full reimbursement of these services, and the lack of adequate procedure pricing lead to chronic underfunding of medical facilities, which threatens the quality and accessibility of healthcare in Poland. Furthermore, late payment of obligations to contractors resulting from delays in the Fund’s transfer of funds results in interest accruing, which burdens facility budgets. Another significant challenge is the misalignment of pricing for medical procedures financed by the National Health Fund (NFZ) with statutory salary increases for medical staff, which generates additional financial pressures and limits the investment capacity of healthcare institutions. These problems stem from the growing funding gap in the National Health Fund (NFZ). According to the report “10 New Sources of NFZ Financing,” prepared by the SGH Think Tank for Healthcare, the projected funding gap in the NFZ, i.e., the difference between statutory expenditures and available funds, will amount to approximately PLN 111.4 billion between 2025 and 2027. The reasons for this deficit are varied, ranging from rising costs related to wages, an aging population, and the need to finance modern medical technologies, to an expanding benefit package and declining revenues from contributions from self-employed individuals. This article discusses the effects of the current financial gap in the healthcare system, felt by both patients and providers. It also discusses possible directions for change that could gradually reduce the financial gap in the healthcare system.
Problems with timely payment of National Health Fund (NFZ) funds
One of the most serious challenges healthcare providers face is delays in payments from the National Health Fund (NFZ), especially for so-called overpayments, i.e., medical services provided beyond the limits specified in contracts. In practice, overpayments are unavoidable, as hospitals and clinics cannot refuse care to a patient requiring medical intervention or suspend operations, for example, mid-year, simply because they have reached a contractual limit. Limiting themselves solely to the provisions of the NFZ contract would mean depriving many patients of access to essential healthcare services. Therefore, healthcare providers, guided by concern for the common good, provide additional services, prioritizing universal access to treatment over economic considerations. They act in the name of the public value of ensuring equal and universal access to treatment. This is an expression of concern for the health of society, as its absence would result in enormous harm, not only to the medical health of individual patients, but also to the social and economic well-being of the entire country. The problem, however, is that the National Health Fund (NFZ) often settles these payments with significant delays, often only after many months. This applies to unlimited services, such as oncology procedures or some outpatient specialist care services, the financing of which stems directly from the National Health Fund’s statutory obligations (Article 136 of the Act of August 27, 2004, on Healthcare Services Financed from Public Funds (Journal of Laws of 2004, No. 210, item 2135, as amended).
In the case of limited overpayments, such as hospital services outside the field of oncology, the Fund sometimes covers only a portion of the receivables, ranging from 50% to 70%. Furthermore, according to recent statements by NFZ President Filip Nowak, full settlement of overpayments of limited services is not planned in the near future, and the period of full financing of such services was an exception related to additional financial reserves following the COVID-19 pandemic.
Settlement of limited overpayments occurs only after the close of the fiscal year, meaning facilities receive payment proposals only in the second quarter of the following year. Often, they receive reduced payments, such as 50% of the funds for services earned over the limit, only in the second half of the following year. In the meantime, they must finance patient treatment from their own funds or take out loans, leading to mounting debt and a risk of financial insolvency. Paradoxically, while fulfilling their ethical obligation to save the health and lives of patients, healthcare providers are falling victim to an inefficient financing system.
It is important to emphasize that delays and incomplete settlement of overpayments by the National Health Fund (NFZ) force medical facilities to act against their own financial stability, demonstrating the urgent need for reform of the healthcare financing system to support, rather than burden, entities fulfilling their public mission.
Interest charged by contractors
Delays in the settlement of overpayments by the NFZ generate serious financial consequences for medical facilities. Entities waiting months for funds owed lose their ability to timely settle their obligations to suppliers of medicines, medical devices, equipment maintenance, and related services. As a result, contractors, concerned about their own financial liquidity, charge statutory default interest. Responsibility for these additional costs, a direct consequence of the National Health Fund’s delays, falls solely on medical facilities, which, in fulfilling their public mission, must cover them from their own budgets.
As a result, funds that could be allocated to treating patients, modernizing infrastructure, or purchasing modern equipment are instead diverted to servicing these obligations. Instead of supporting public health, this financing mechanism paradoxically undermines it, burdening facilities with costs resulting from a flawed system.
This begs the question: Why is the National Health Fund (NFZ) not responsible for the resulting damage? After all, it not only financially destabilizes medical facilities but also limits their ability to fulfill their healthcare mission, thus undermining the common good.
Annual Pay Raises for Medical Staff and National Health Fund (NFZ) Pricing
For a decade, Poland has had a statutory mechanism for annual salary increases for medical staff. From a public value perspective, this solution is fully justified, as doctors, nurses, paramedics, and diagnosticians fulfill a mission of fundamental social importance and deserve decent working conditions. The idea of pay raises also remains valid because for many years, salaries in the healthcare sector remained significantly lower than the European average, which led to staff frustration and contributed to the exodus of medical staff to the West.
The problem, however, is the lack of linkage between rising labor costs and the pricing of medical procedures set by the National Health Fund (NFZ). The state obliges hospitals to pay raises without providing sufficient funds to finance them. As a result, medical facilities are struggling with a growing gap between revenues and costs, forcing them to seek savings or incur debt instead of investing in development and improving the quality of services. The lack of systemic cohesion undermines the noble goal of raising employment standards in healthcare, and the costs of achieving this common good are shifted onto already struggling institutions.
It should be noted that some voices point to the harmfulness of this law. Therefore, meetings were held between representatives of the Presidium of the Tripartite Group for Healthcare regarding the future of the Minimum Wage Act in Healthcare. Available information indicates that key meetings took place in June and July 2025. These meetings did not yield any final decisions. The discussions focused on the need for changes to the Act due to its impact on the finances of the National Health Fund (NFZ) and hospitals, but the parties (trade unions, employers, and the Ministry of Health) often have divergent positions.
Consequences for Patients and the System
Underfunding, delays in payments for overpayments, and the failure to adjust medical procedure pricing to rising costs, including statutory staff salary increases, are leading to a profound destabilization of the healthcare system. These effects are felt most acutely by patients, who struggle with lengthening wait times for healthcare services due to the limited number of procedures financed by the National Health Fund (NFZ). A lack of funds for investment in modern equipment and hospital infrastructure limits the quality and access to care, while the need to repay interest on late payments to contractors consumes funds that could be allocated to facility development. Furthermore, the financial instability of the system discourages medical specialists from working in the public sector, leading to an outflow of personnel to the private sector and a decline in the quality of treatment. As a result, the foundation of the public healthcare system—equal and universal access to services—is gradually weakening, threatening the health security of citizens and the common good.
Possible New Financing Sources
The problems mentioned are undoubtedly a result of the insurance funding gap in the National Health Fund (NFZ). The authors of the report “10 New Sources of Financing for the National Health Fund” by the SHG Think Tank for Healthcare calculated that the insurance funding gap will total approximately PLN 111.4 billion between 2025 and 2027, which will exacerbate the aforementioned problems. Therefore, the goal of healthcare policy should be to implement corrective measures that will reduce the funding gap in the coming years.
The SGH Think Tank for Healthcare report presents several possible corrective measures. One of these is increasing the health insurance contribution. It is assumed that increasing this contribution by 0.25 percentage points annually for four years and limiting eligibility for preferential insurance with the Agricultural Social Insurance Fund (KRUS) could generate approximately PLN 36.6 billion in additional revenue between 2025 and 2027. However, this burden would fall primarily on employees and the self-employed.
The second proposal is to introduce a health insurance contribution partially financed by employers. A new contribution of 2.5 percent of gross salary paid by companies could contribute approximately PLN 41.9 billion to the National Health Fund (NFZ) budget between 2025 and 2027. This solution would bring Poland closer to the models in place in many European Union countries, but it would also mean higher labor costs.
Another measure that could increase revenues is extending and equalizing the retirement age for women and men to 65, and ultimately to 67. This change would increase the share of working people in the number of retirees and could generate an additional PLN 5.7 billion between 2025 and 2027.
The report also highlights the need to finance contributions for children from the state budget. Currently, approximately seven million children benefit from healthcare without paying contributions. Implementing a solution where their insurance would be financed from the state budget could generate an additional PLN 16 billion annually, or approximately PLN 48 billion over the three-year period under review.
Slightly smaller, but still significant, revenues could come from increasing the so-called “children’s pension contribution.” Taxes on “health sins” such as sugar, alcohol, and tobacco taxes, as well as the introduction of new levies, such as the fat tax, could also generate additional funds through co-payment mechanisms for selected services and the development of private health insurance. Collectively, these measures could generate approximately 2–3 billion złoty between 2025 and 2027.
To reduce the financing gap, action will be necessary on many fronts. Raising employee contributions alone will not solve the problem; greater state budget involvement, greater employee and employer participation in system financing, and demographic changes related to longer working lives are necessary. Better cost management and greater spending efficiency will also be important. A combination of these measures can significantly reduce the gap, although each requires political decisions, legal changes, and public acceptance.
Expected effects of the proposed financing changes
Reducing the funding gap in the National Health Fund could pave the way for implementing solutions that would allow healthcare providers to operate sustainably while ensuring broad and safe access to healthcare for the public. Below are key practices that could support such a model:
- Timely settlement of overpayments, especially in the case of unlimited services, which are unavoidable and require payment under the Act of August 27, 2004, on Healthcare Services Financed from Public Funds. Ensuring predictability in this regard would allow medical facilities to operate stably.
- The interest cost compensation mechanism, which prevents delays in financing, should generally be avoided, but if they do occur, they should not burden medical facilities alone. Implementing an effective compensation system is essential to ensuring financial stability for healthcare providers.
- Realistic pricing of medical procedures should reflect actual labor and material costs and take into account annual salary increases for medical staff.
In addition to implementing measures to increase healthcare spending, it is also worth considering reforming the service contracting system. The current model, based on rigid limits, generates overperformance, so more flexible contracts based on the actual health needs of the population could alleviate the problem of facility debt.
The predominance of inpatient treatment and low spending on preventive care and outpatient care make the system less efficient than in Western European countries.6 Countries such as Germany, Denmark, and the Czech Republic are investing more in health, which translates into better access to services and a reduced burden of private costs on patients. Poland plans to increase spending to 7% of GDP by 2027, but proper resource allocation will be crucial. To match Western European standards, we would need to take a long-term view of public health, investing in effective preventive programs and striving for better public health. The goal of such actions would be to raise awareness among Poles about the importance of preventive care, thus reducing the need for late and costly treatment. Only such an approach offers a chance to create a healthcare system that is both efficient and equitable.
Summary
Medical entities providing services to patients under contracts with the National Health Fund (NFZ) are facing increasing financial challenges. The main cause of these growing difficulties is the insurance funding gap, i.e., the difference between the actual costs of healthcare and the funds allocated to its financing, which is widening each year. Delays in payment of due funds are an additional burden, forcing facilities to incur interest charges and rely on revolving credit facilities. Statutory increases in salaries and operating costs, which are not reflected in current pricing for medical procedures, also pose a problem, causing revenues to fail to keep pace with rising expenses. As a result, many hospitals and clinics are teetering on the brink of financial insolvency, and mounting debt is destabilizing the entire system. Unless additional funding sources are activated soon and legislative and organizational changes are implemented, the situation will worsen. Ultimately, patients will suffer, experiencing limited access to services, longer waits and a decline in the quality of healthcare may become commonplace if we do not take corrective action today.
Bibliography
- Act of August 27, 2004, on Healthcare Services Financed from Public Funds (Journal of Laws of 2004, No. 210, item 2135, as amended).
- Act of June 8, 2017, on the Method of Determining the Minimum Basic Salary of Certain Employees in Healthcare Facilities (Journal of Laws of 2017, item 1473).
- Supreme Audit Office, “Hospital Financing by the National Health Fund,” NIK Report, Warsaw 2021.
- Ministry of Health, “Strategy for the Healthcare System for 2021–2027,” Warsaw 2021.
- Healthcare System Profile 2023 https://www.oecd.org/content/dam/oecd/pl/publications/reports/2023/12/poland-country-health-profile-2023_80434439/b12d3d03-pl.pdf
- Raulinajtys-Grzybek, M. Więckowska, B. Świerc, Z. Białoszewski, A. 10 New Sources of National Health Fund Financing. SGH ThinkTank for Healthcare, 2025. https://gazeta.sgh.waw.pl/sites/gazeta.sgh.waw.pl/files/zalaczniki-2025/10-nowychzrodel-finansowania-nfz.pdf