Financing Healthcare at the Local Level
The growing debt of hospitals, lack of financial stability, and tensions surrounding the remuneration of medical personnel are problems that have dominated public debate for months. In the face of these challenges, a discussion panel devoted to financing healthcare at the local level was held during the Forum of Local and Regional Authorities in Zakopane.
The panel featured: Tadeusz Zaremba, Starost of Nowosądecki County; Maciej Miłkowski, Coordinator for Financial Analytics at the Military Medical Institute; Krystyna Walendowicz, Director of the Provincial Rehabilitation Hospital named after Dr. S. Jasiński in Zakopane; Adam Styczeń, Director of the Independent Public Healthcare Institution in Myślenice; and Mirosław Dróżdż, Councilor of the Małopolska Region. The panel was moderated by Jacek Bilski, Vice-President of the Management Board of Supra Brokers S.A.
One of the key topics was the relationship between the public and private sectors. Panelists discussed the possibility of introducing a statutory ban on combining NFZ financing with commercial services within a single facility. Experts emphasized that the current model fosters inequalities—private entities perform mainly well-priced procedures, leaving public hospitals with the most difficult cases. According to the participants, the priority should be strengthening the public sector, which is responsible for the country’s health security. As Director Krystyna Walendowicz noted: “The public system must function well first. Private entities are needed, but as a complement, not the foundation.”
The panelists also addressed the issue of “over-performance”—services provided beyond the limit set by the NFZ, which are a daily reality for many facilities. Adam Styczeń, director of the hospital in Myślenice, drew attention to the imbalance in settlements: “We are not overproducing. Patients arrive in emergency mode, ambulances bring them every day. And the NFZ settles our services worse than those contracted separately. The disparity is enormous.”
Experts unanimously assessed that finances—not lack of potential—are the bottleneck. The current system rewards separately contracted entities, while hospitals operating under lump-sum financing receive significantly lower compensation. According to the panelists, it is necessary to standardize financing rules and introduce mechanisms that reflect the real needs of patients. As summarized by Maciej Miłkowski from the Military Medical Institute: “Operating theaters could work 12 hours a day, but the NFZ doesn’t have the funds.”
The participants also responded to voices appearing in public debate about the need to reduce the number of hospitals. Panelists stressed, however, that government documents mention consolidation and the creation of consortia—not closure of facilities. They pointed to the need for flexible resource management—transforming acute-care beds into long-term ones and rationally distributing hospital departments. Starost Tadeusz Zaremba highlighted the strategic role of county hospitals: “County hospitals are critical infrastructure. At a time when we talk about civil defense, we cannot concentrate everything in a few large centers. That is a strategic risk.”
The discussion also covered the topic of medical personnel remuneration. The current model, in which some doctors are paid as a percentage of the value of the procedure, is controversial. According to Director Krystyna Walendowicz, hospital directors contracting services with doctors did not foresee that the increase in point valuation and procedures would be so significant. “Currently, salaries are included in the price of the procedure, which means that for highly specialized services, the percentage-based payments for doctors rise very sharply. Is that good? I don’t know, but since this is how the system works, it must be reviewed and moderated.” Directors pointed out the lack of consistency—their own salaries are legally capped, while the costs of doctors’ and nurses’ remuneration are rising at a pace the system cannot sustain. Mirosław Dróżdż, Councilor of the Małopolska Region and director of the hospital in Miechów, stressed:
“The employment costs of nurses are now comparable to those of doctors, and the ongoing court disputes concerning professional classifications may lead to a significant increase in wages—to as much as 20,000 PLN. This is a burden that the current financial system cannot sustain.”
The panel concluded with an appeal for bold decisions and comprehensive system reform. Experts emphasized that the current model is fragmented, and the lack of coordination between management levels exacerbates financial problems. They pointed to the need to standardize financing rules, strengthen the role of the public sector, rationalize hospital structures without drastic reductions, and create mechanisms that stabilize remuneration.
The participants also expressed the conviction that the Polish healthcare system has solid foundations and can meet its challenges, provided that changes are introduced in a thoughtful and coordinated manner.
