Perpetual Crisis in Polish HealthCare System. Policy Drift, Misleading Narratives and Self-Sabotage

Polish healthcare system appears to be in a perpetual crisis and somehow it is becoming worst every year. By the end of the 2025 it has become increasingly clear that in the upcoming 2026 the National Health Fund (NHF) will have a deficit of 5,7 billion EUR (23 billion PLN). Hospitals reported delays in NHF payments leading to delays in services (and waiting times) as well as growing number of refusals to cover services provided legally but over the contractual limit. And yet just few months earlier the government attempted to reduce healthcare contributions for the self-employed incl. with higher incomes (Poland ranks 3rd in the EU with highest levels of self-employment). If it were not for the presidential veto this reform would have resulted in even higher NHF deficit and a deeper crisis. In this paper I investigate sources of the current crisis – from the most direct causes, through structural-systemic conditions, up to long lasting fallacious assumptions and narratives prevalent among decision-makers, stakeholders and even experts. I discuss the critical role of the 2022/23 reform (Dz.U. 2022 poz. 2770) that tasked statutory insurance’s NHF with financing multiple non-insurance based services – most notably medical rescue, mandatory vaccinations, etc. Up to that point, these were financed from the state budget as guaranteed regardless to their statutory insurance status. The reform was introduced when the NHF had a budgetary surplus due to unrealized healthcare services during the COVID-19 pandemic and later due to lack of medical personnel. The surplus was also a result of new tax reform that increased the healthcare contributions for self-employed higher-income individuals. I also explore the long-lasting issue of endemic public hospital debt crisis that dates back to early 2000s. Predominant policy narrative about inherent proneness of independent public hospitals to mismanagement fuelled multiple (more-or-less failed) attempts at their commercialisation (i.e. transformation into capital companies). However, recent studies (Dubas-Jakóbczyk et al. 2020) show that the assumptions about this solution was empirically unfounded and might even have been counter-effective. Moreover, a 2019 ruling by the Polish Constitutional Tribunal (Dz.U. 2019 poz. 2331) indicated that the very problem is a result of unconstitutional law that burdens local governments with debts that should be a liability of the NHF as legally responsible for funding guaranteed benefits basket. The current crisis appears to be a culmination of a: (1) chronical policy drift – without consistent vision and with possible ulterior motives (creeping privatization and commercialization); (2) misleading narratives about the problem – prevalent even among experts and deriving years of misguided reforms; (3) as well as self-sabotage resulting from ad hoc, short-term, politically motivated decisions.