NFZ hole: Will a 90% pay raise for medical staff destroy the system?

A statutory 90% increase in medical staff wages, combined with a projected budget gap exceeding PLN 200 billion, is forcing the NFZ to make drastic cuts in funding for medical services, which directly limits patient access to healthcare. The healthcare system in Poland has ceased to fulfill its therapeutic goals, becoming a passive distributor of funds for mandatory wage obligations. The payer's finances are unable to sustain the current model without compromising actual treatment, leaving hospitals in a hopeless situation.

Architecture of debt: a 200 billion zloty balance sheet

The foundations of the healthcare system in Poland have eroded. Data published on February 19, 2025, by pulsmedycyny.pl indicated a gap in the payer's budget exceeding PLN 200 billion. This amount exceeds almost the entire planned health budget of PLN 222 billion. The discrepancy between projected contribution revenues and actual expenditures on statutory raises and medical care has become impossible to bridge under the current financing model.

As early as September 1, 2024, OKO.press experts questioned the realism of the PLN 222 billion budget, pointing to a chronic underestimation of needs. Today, these numbers are not just an accounting issue. They are parameters that determine the number of surgeries, diagnostic tests, and specialist visits that the NFZ will not fund. The system, which was supposed to guarantee safety, is operating with a deficit that has been growing for years, ignoring signals from the medical labor market.

The problem does not stem from a temporary cash shortage. It is a structural mismatch between rigid wage obligations and contribution revenues that are not keeping pace with medical cost inflation. Every billion zlotys shifted toward wage increases in the face of a gap of this scale is money that cannot be spent on purchasing modern equipment or subsidizing medicines. The lack of balance between revenues and costs makes the patient a "variable cost" that can be cut first.

Wage mechanism: a statutory challenge to liquidity

The statutory 90 percent increase in medical staff wages has become the main burden on the NFZ budget. These obligations, resulting from legal regulations, have outpaced the real growth rate of contribution revenues. According to data from PKB24.pl from October 20, 2025, real doctor wage rates have increased in a way that is not covered by the point-based valuation of medical services. This means that every hour of work by medical personnel costs the system more than before, while the revenues of medical facilities remain at the level from before the raise cycle.

This situation forces hospital directors to redefine priorities. When wage costs consume the majority of a contract, facilities lose the ability to fund excess procedures. Patients with chronic illnesses, requiring regular care, are pushed out of the system or forced to use commercial services. The private sector, although gaining popularity, is unable to replace public healthcare in terms of complex hospital procedures. As a result, a patient who does not have private insurance loses a real chance for timely treatment.

The introduction of such high raises without reforming the service valuation model has led to decision-making paralysis. Medical facilities, instead of investing in development, are focusing on maintaining financial liquidity, which means halting infrastructure investments. This phenomenon is most acute in smaller centers, where budgets are more rigid and cost-optimization opportunities are limited.

Consequences for the patient: queues instead of treatment

The refusal to pay for excess procedures, which was warned about on April 2, 2026, in "Dziennik Gazeta Prawna," is a direct consequence of the lack of funds in the NFZ coffers. Hospitals that have admitted a larger number of patients than the contract provided for are left with debts they have no way to cover. In practice, this means that after exceeding the limit, medical facilities drastically limit elective patient admissions.

For the patient, this means having to wait for procedures beyond reasonable timeframes. Cataract surgeries, endoprostheses, or oncological diagnostics are becoming procedures available only to those who are either lucky or have the financial resources for private treatment. The system, which was supposed to be universal, is becoming selective through the mechanism of queues, rather than through clinical decisions.

Hospitals, not receiving reimbursement for work performed, are limiting purchases of medicines and medical materials. The quality of care is declining, and doctors are forced to work in conditions of permanent resource shortages. This is not a temporary situation. It is a state in which the healthcare system ceases to fulfill its guarantee function. The patient is left with a prescription or a referral that, in financial reality, becomes merely a document without coverage.

Expert perspective: diagnosis by Prof. Grzegorz Gielerak

Prof. Grzegorz Gielerak, director of the Military Institute of Medicine, pointed out on the PolitykaZdrowotna.com website as early as April 28, 2026, that Poland's current health policy requires immediate verification. His opinion emphasizes that the problem does not lie in individual management errors, but in the very construction of the system, which has ceased to be adequate to demographic and financial challenges. The expert points out that ignoring signals from the market will lead to irreversible losses for public health.

The key problem is the lack of a coherent strategy that would link wage increases with improvements in system efficiency. Instead, we are dealing with a drift where every subsequent financial decision is merely a reaction to a crisis, rather than an attempt to build stable foundations. Prof. Gielerak points out that without a fundamental change in the way of financing, continuing to maintain current standards of care is impossible.

In the medical community, there is a growing conviction that the current situation is the result of many years of neglect in the area of planning. Experts recall that as early as 2024, warnings were issued about a budget hole of around PLN 160 billion (money.pl, June 25, 2024). The lack of appropriate action at that time made today's crisis much deeper and more difficult to manage. Every month of delay in reform increases the cost that the patient will ultimately bear.

Financial planning as improvisation

The description of the NFZ financial plan as a document written on a napkin, used by Serwis Zdrowie on March 19, 2025, accurately reflects the atmosphere of uncertainty in managing the health budget. The lack of predictability of revenues and the chaotic approach to expenditures have caused this institution to lose credibility as a payer. Crisis management has become the norm, and long-term planning has become a fiction.

In public administration, there is often a lack of courage to admit that funds are insufficient to fulfill all statutory promises. Instead, creative accounting is used, shifting payments to subsequent years or limiting the availability of services. This approach does not solve problems, but only delays them, making them more costly in the long run.

This situation affects not only hospitals but also primary care and specialist clinics. When the payer limits funds, every medical facility must look for savings. Most often, this happens at the expense of time spent with the patient or the quality of materials used. Such a strategy is short-sighted and leads to a deterioration in the health of the society, which in the future will generate even higher costs for the state budget.

Dependence on the state budget: NFZ in a trap

Without subsidies from the state budget, the NFZ is unable to fulfill its tasks, as was reported as early as June 26, 2024, on the infoDENT24 website. This institution has ceased to be self-sufficient, becoming completely dependent on the government's political decisions. This creates the risk that medical priorities will be dominated by ad-hoc goals, rather than by the needs of patients.

Dependence on subsidies means that every change in the state budget immediately translates into the financial stability of healthcare. In the face of a budget gap, the government faces a choice: either increase the subsidy, which means higher state debt or higher taxes, or allow cuts in services. The current policy points to the latter solution, which directly hits the patient.

The financial situation of the payer is critical at this moment. Even assuming optimistic economic forecasts, a gap exceeding PLN 200 billion is impossible to patch without deep reform. Patients must reckon with the fact that access to many guaranteed services will become theoretical, not practical. The healthcare system needs stable financing, not ad-hoc capital injections that only prolong its agony.

Patient perspectives: reality without guarantees

The financial crisis in the NFZ translates into concrete difficulties in the life of every citizen. Patients struggle with lengthening queues for specialists, lack of access to imaging tests (MRI, tomography), and difficulties in accessing rehabilitation. This is a situation in which the right to medical care, enshrined in the constitution, becomes a dead letter.

Only professional groups covered by statutory raises are gaining, but on the scale of the entire system, this is a short-term success. Without efficient hospitals, high-quality diagnostics, and available medicines, even the best-paid staff will not be able to treat effectively. Patients in this arrangement become victims of a lack of competence in planning public resources.

In the face of such a huge budget gap, it is worth asking about responsibility for the current state of affairs. Politicians are eager to announce subsequent health programs, but rarely point to the sources of their financing. This leads to the disappointment of patients who, after entering the healthcare system, collide with the brutal reality of shortages and limitations. The patient is not just a beneficiary of the system; they are its main guarantor, who pays contributions, expecting in return real help, not bureaucratic announcements about the lack of spots in queues.

Questions and answers

Will the patient feel the lack of money in the NFZ?

Yes, through a drastic lengthening of queues for specialists and the lack of funding for excess procedures in hospitals, which will limit the number of surgeries performed.

How much is the real hole in the NFZ budget?

The projected budget gap of the payer exceeds PLN 200 billion, which is the result of accumulating costs, including medical staff wage increases that are not covered by revenues.

Are raises for medical staff the only reason for the crisis?

They are a key factor depleting the budget, but the problem also stems from faulty budget planning, the lack of sufficient targeted subsidies, and the chronic underestimation of the costs of services.

Why are hospitals refusing admissions?

Hospitals are refusing non-limit admissions because the NFZ has stopped paying for excess procedures, and facilities do not have their own financial reserves to cover the costs of treating these people.

Was the NFZ financial plan consulted with experts?

Despite numerous warning voices from the expert community, including Prof. Grzegorz Gielerak, the fund's financial plan was created without taking into account the real costs of labor and the growing budget gap.

What awaits the patient in the coming years?

If a radical financing reform does not occur, the patient must prepare for even more difficult access to specialists and longer waiting times for elective surgeries, which for many people means the necessity of financing treatment out of their own pocket.

Summary of the system's state

The healthcare system in Poland has reached a turning point. Statutory raises for medical staff were necessary in the face of labor emigration and an aging staff, but their introduction without a simultaneous reform of the financing system proved to be a mistake with catastrophic consequences. A budget gap of PLN 200 billion is not just a figure. It is thousands of unperformed surgeries, millions of hours of waiting in queues, and a sense of hopelessness among the sick who have been left to fend for themselves.

Authorities must decide whether healthcare is a state priority or just an area where shortages are managed. Without transparency in finances, fair valuation of services, and a realistic approach to costs, the system will continue to lose efficiency. The patient who pays a contribution today has the right to expect that in case of illness, they will receive help. Currently, this promise is not being kept, and the responsibility for this state of affairs rests with those who created law inadequate to the payer's capabilities.

Further pouring funds into the system without structural changes will only deepen inequalities and discourage patients from using public healthcare. The private sector, although flexible, will not solve the problems of oncology, cardiology, or geriatrics, which require huge investment outlays. The future of healthcare in Poland depends on the courage to make difficult financial decisions that will take into account the real condition of the state budget and the actual needs of the patient, and not just the short-term wage demands of various professional groups.

The current model, in which the NFZ acts as a hostage to its own obligations, is unsustainable. Every subsequent year in this state of affairs is lost time for patients whose health cannot wait for the correction of accounting errors. If health policy is not verified in the near future, the system faces inevitable paralysis, in which the only form of functioning will remain the payment of salaries while simultaneously shutting down medical activity. This is a scenario that experts warn about and whose consequences we will all feel – regardless of wealth status or place of residence.

Ultimately, the healthcare system must serve patients. If it ceases to do so, it loses its reason for existence. Any attempts to explain oneself with mathematics that refuse to add up are just an admission of failure in managing a common good, which is the life and health of citizens. Changes are required that will restore the balance between the needs of staff and the rights of the patient, because without them, with each passing day, the healthcare system will be less public and more unattainable for the average Pole. Solving this dilemma should be a priority for anyone who takes responsibility for the health of the nation. Otherwise, in a few years, we will be discussing not queues, but the total collapse of public medicine.

Sources

Article prepared by the Wiadomości PRO editorial team with the support of artificial intelligence. Facts come from the sources listed above.