Constitution of the Republic of Poland (art. 68) /OJ1997, No 78 item 483/guarantees:
• „Everyone has the right to health care.”
• „Public authorities guarantee citizens, regardless of their material status, an equal access to health care services financed from public funds.”
The beginning of the new post-socialist economical system started in 1989. Until 1998 almost all healthcare was financed from the general state budget. from 1999 – III 2003 a universal health insurance system functioned based on 17 so called „sickness funds” and then in 2003 a single payer model with National Health Fund „Narodowy Fundusz Zdrowia” (NFZ) was established. NFZ is the single national payer for health care services. It receives funds from special taxation called health premiums. calculation of healthcare premiums is complicated and depends on the personal income, form of employment and special circumstances (i.e. for farmers). National Health Fund is supervised by the Ministry of Health. It acts not for profit and is divided into 16 provincial departments that manage contracting with healthcare providers.
Until now the system was based on Act of 27th August 2004 on health benefits financed from public funds, the Act of 30th August 1991 on health care institutions, the Act of 8 th September on Public Emergency Healthcare System.
For the past 2 decades health care system in Poland has been divided into 4 main sectors of healthcare:
• Primary Health Care „POZ” (Primary care physician acts as a „gate keeper” to higher levels of the healthcare system) – this sector is composed of many small private practices and some hospital based primary care centers.
• Specialized Out-Patient Care „AOS” (mostly referral based) – this sector is mixed, there are many private group specialty practices and publicly owned clinics, mostly multispecialty. Some are attached to hospitals, more are free standing.
• Inpatient Health Care (Hospitals)
• Emergency Health (public system called national Emergency care System with many modern ambulances and over 20 modern medical helicopters.
And several special areas like:
– Long-Term healthcare, rehabilitation facilities, home care and hospices
– Psychiatric hospitals and outpatient care
– Health Resorts, „sanatoriums”.
In the last decade over 580 hospitals (defined as facilities with 24/7 emergency care services and inpatient care) and several hundred of short stay / day surgery hospitals have been in operation in Poland. Most of hospitals are publicly owned, acting as non-profit organizations, or incorporated (90% of those with emergency care services and 24/7 inpatient care) while most of other hospitals are private. Majority of hospitals provide services financed from public funds administered by the National Health Fund.
In 2017, the hospital sector in Poland changed significantly. The national network of hospitals was voted in favor by the Polish Parliament in May of 2017. The new network was fully implemented in October 2017.
National Hospital Network, called officially the System of Fundamental Hospital Care Coverage, commonly known as the “Hospital Network” divides hospitals into 6 levels, all providing emergency care and inpatient services 24/7, some of them only care related to their specialty profile (oncology, pulmonary and pediatric).
• 1st level (with 4 basic departments: surgery, internal medicine, gynecology and obstetrics, and pediatrics) – mainly county hospitals, up to 42% privately owned or with mixed ownership – operational model.
• 2nd level (hospitals having 4 basic departments plus 2 specialized departments) – larger county and some city hospitals, some privately owned.
• 3rd level (hospitals having 4 basic departments plus 6-8 specialized departments) – larger regional hospitals, all publicly owned.
And 3 specialized levels:
– Children’s hospitals
– Oncological hospitals and Pulmonology hospitals
– Nationwide hospitals (university hospitals and national research medical institutes)
Additionally, oncology, which is the priority discipline for the State is financed without cap limits.
The list of hospitals approved to the Hospital Network was presented on 27th of June, 2017.
These hospitals are financed by general budgets assigned to them by the National Health Fund. Such budgets may be revised every few months depending on productivity.There is also some financing related to procedures (fee-for-service), outside of global budgets, it depends on the type of hospital and its place in the National Network
Hospitals outside the Network may apply for contracts with the National Health Fund, however the amount of money available for that is only around 10 % of the total public financing of hospital care of 66 bln PLN (amount planned for 2023). The 90% of total hospital care budget is dedicated to in-Network hospitals. The other hospital network related regulation is a restriction on purchasing more than 51% of shares in public hospitals (only those that are incorporated) by private investors.
Most private hospitals are out of the Network, these are mostly procedure oriented ambulatory surgery or one-day surgery centers, without emergency care and not operating 24/7. There are 72 privately owned (or with mixed, >50% ownership, or publicly owned hospital infrastructure but operated by private companies) hospitals in the National Hospital Network – most at level 1, some at level 2.
The other reform of the Poland’s health care system was the implementation of publicly owned entities as the only providers in the National Emergency Health Care System (Comprehensive emergency care model established in 2006 allowed also private companies to operate in the system).
In 2019, the nationwide e-prescription and e-referral system, followed by the patient’s internet account were implemented. Telemedicine has rapidly developed since 2020 and is now very popular in outpatient care
Accordingly to the 2023 National Health Fund budget, the total value of publicly financed healthcare services is going to reach 144 bln PLN. Private financing of healthcare is predicted to reach close to 70 bln PLN in 2023. Central Office of Statistics reports that the total value of financing of healthcare in Poland amounted to 173 bln PLN, equalling 6.6% of GDP in 2021, 47 bln PLN were private financing out of which, 33 bln PLN were direct out-of-pocket payments (19% of the total healthcare payments) and 14 bln PLN were employer sponsored pre-paid care and private healthcare insurance. Private healthcare financing in 2021 was 27% of the total healthcare financing.
Interestingly, in 2023, only 1.4 bln PLN is the amount planned to cover the administrative costs of the National Health Fund. Poland’s National Health Fund is one of the least costly healthcare financing institutions in the world, as its administration amounts only to 1% of the total budget.