Who Is Responsible for the Hospital? A Debate on the Future of Polish Hospital Care
During the panel “Who Is Responsible for the Hospital? Various Founding Bodies and Their Impact on the Functioning of the Healthcare System,” held as part of the Forum of Local and Regional Authorities in Zakopane, experts discussed one of the most challenging topics—the condition of Polish hospitals and the role of local governments in the system.
The discussion featured Lidia Zelek, Director of the Jędrzej Śniadecki Specialist Hospital in Nowy Sącz; Tadeusz Chrzan, Member of the Polish Parliament; Piotr Magdziarz, Managing Partner at FORMEDIS sp. z o.o.; and Mirosław Dróżdż, Councillor of the Małopolska Regional Assembly. The session was moderated by Krzysztof Zdobylak, a healthcare transformation expert, who at the outset outlined the scale of the problem: “The system is facing a crisis of financing, efficiency, and leadership.”
The moderator pointed out that public hospital debt now reaches 25 billion PLN, with annual expenditures on hospital care at nearly 100 billion PLN. “That’s one quarter of the revenues—significant, but not unprecedented compared with other countries. The problem is that Polish hospitals incur debt not for investments, but for everyday operating costs,” he emphasized. Added to this is an efficiency crisis—lack of a coherent vision, fragmentation of ownership structures, and unclear boundaries of responsibility. “We have more than 600 hospitals, half of them county-level facilities, and each operates in a different environment with different priorities,” he noted.
The first to speak was regional councillor Mirosław Dróżdż. “The boundaries of responsibility are clear—the local government must ensure residents have access to services. The problem is that the financial equation doesn’t add up. Salaries rise by law, staffing requirements are increasing, and funding growth is not keeping pace,” he said. In his view, closing departments is the simplest but worst solution: “This will increase queues and reduce health security. The capacity of hospitals is necessary—the pandemic showed that.”
Member of Parliament Tadeusz Chrzan followed, addressing finances and ownership structure. “Let’s not demonize fragmentation—local governments invest huge amounts in infrastructure, even though they don’t have to. Without these expenditures, hospitals would look dramatic today,” he stressed. At the same time, he emphasized that the problem is not only a lack of money: “The system is leaky. No matter how much we add, it will never be enough. In eight years, the healthcare budget increased from 90 to over 200 billion PLN, and the situation is not significantly better.” MP Chrzan pointed out the need for comprehensive reform rather than sector-specific fixes: “We must answer the question of whether health is a commodity. If it is, privatize everything. If not, let’s develop a strategy that transcends political divisions.”
Lidia Zelek, Director of the Specialist Hospital in Nowy Sącz, presented the reality of everyday challenges. “The population is aging, there are more and more patients, and the prices of many procedures do not cover the costs. In oncology, drugs have gone unpaid since the second quarter, yet you cannot deny the patient another treatment cycle. You must have the means to purchase the medications—companies won’t provide them for free,” she said. She also highlighted the dramatic situation in hospital emergency departments: “We admit 180 people per day—we are the second busiest hospital in Małopolska. Many of them are primary-care cases because family doctors refer patients to the ER, where full diagnostics are available. That generates costs and overwhelms the staff.”
Piotr Magdziarz of Formedis proposed concrete directions for change: “We must align the healthcare services package with the level of healthcare funding. Either we increase financing, or we limit the package and introduce supplementary insurance.” In his view, strengthening primary care and prevention is crucial: “A strong family doctor is the system’s gatekeeper. In Denmark, 85–90% of patients’ needs are met by primary care. Here, it’s the opposite—the patient ends up in the hospital because primary care is weak.”
Magdziarz also advocated for resource consolidation: “A hospital must be efficient and invest in new technologies. It cannot balance its budget with a population of 50,000. Consolidation is needed—instead of three weak facilities, one strong hospital with a surgical base, and in the remaining ones long-term care and non-surgical departments.”
All panelists agreed that without better coordination of care and system digitalization, reform will fail. “It cannot be that a director spends the night calling hospitals across the region looking for an available bed. The system should handle that,” Magdziarz emphasized.
MP Tadeusz Chrzan added: “We must implement full digitalization—no repeated tests, no paperwork. This is technologically possible; it only requires political will.”
The panel concluded with a shared conclusion: reform must be swift, comprehensive, and above political divisions. “No transformation planned over decades will succeed—momentum and a clear timeframe are needed,” the moderator summarized.
The experts identified three pillars of change:
• Efficiency and coordination – strong primary care, prevention, and resource concentration.
• Digitalization – a digital patient record, data integration, simplified procedures.
• Stablefinancing – aligning the services package with expenditures, clear investment rules.
“The system requires courage and cooperation. If these are lacking, the crisis will deepen,” the participants concluded.
