Expert on the National Health Fund's financial plan: we are flying on autopilot, but without access to the cockpit
- In 2024, the NFZ financial plan for 2025 was not approved by anyone. And what? And we are still in the game - points out attorney Beniamin Kołodziej
- He adds that from the perspective of the service provider, nothing has changed. - Contracts are in place. Agreements are being implemented. Financing schedules remain unchanged. No one is suspending services, no one is suspending branches - he points out.
- - The patient? The patient is still waiting in line to see the endocrinologist. And whether the plan has been signed or not - for him the difference is smaller than between "NFZ pays" and "NFZ pays later" - he explains
- He states that the problem begins when the system needs correction.
There is an unwritten rule in the Polish healthcare system: if something is supposed to work, it will work - even if it formally shouldn't. The latest episode of this series is the story of the National Health Fund's financial plan for 2025, which was not approved. And what? And nothing. The fund is working. Hospitals are working. Benefits are being financed. And the patient? Well, the patient, as usual, didn't notice anything.
In theory, a financial plan is sacred. In practice, it is enough that someone once wrote it.
According to art. 121 of the Act on healthcare services financed from public funds, the procedure looks like a management manual: the president of the National Health Fund prepares a draft plan, sends it for opinion (parliamentary committees, Fund Council), and then "the minister responsible for health, in consultation with the minister responsible for public finances, approves the financial plan of the Fund" (art. 121 sec. 4 of the Act).
Keyword: "agreement". So not a joint signature, but consultations. And the signature is submitted by the Minister of Health. Theoretically by July 31 of the previous year. Except - surprise - in 2024 the plan for 2025 was not approved by anyone. And what? And we are still in the game.
The legislator has foreseen this scenario. In the absence of approval, the version presented by the president of the National Health Fund is in effect. That is, something like a "working version", but one on which the entire complex public health care system can function. There is no approval in it, but there is money. There is no political agreement, but there are transfers. Benefits are settled, competitions are announced, and no one mentions the problem on the hotline.
This is not a legal loophole. This is a legal stopgap. And - as is the case in Poland - stopgap with the prospect of a full year of operation.
From the perspective of the service provider - nothing has changed. Contracts are in place. Agreements are being implemented. Funding schedules remain unchanged. No one is suspending services, no one is suspending branches.
Patient? The patient is still waiting in line to see an endocrinologist. And whether the plan has been signed or not - for him the difference is smaller than between "NFZ pays" and "NFZ pays later".
The problem begins when the system needs correction. New tasks, changes in valuations, rising costs, overperformance, inflation, statutory increases - all this requires a financial plan amendment. And this cannot be done if there is no approved base plan.
Not approved? This cannot be amended. Do you want to shift funds to psychiatry? Tough. Do you want to add to preventive programs? Wait. Do you want to respond to a crisis situation? Maybe next year.
The system works - but on tracks that were set up last season. And there are no switches. According to Article 124 of the Act on Healthcare Services Financed from Public Funds, only changes to the approved financial plan of the Fund are made.
Approval of the financial plan is not a technical procedure. It is a political act. The Minister of Finance did not sign the plan because - quoting Deputy Minister Neneman - "the plan did not include many tasks of the National Health Fund". In other words, de facto, the costs of statutory increases or new programs were not included. The Minister of Finance did not want to sign a document that was already impossible to implement on the day of its announcement.
On the other hand, the Minister of Health did not press. Because approving a document with a hole is also an act of accepting responsibility. And if you can not approve and continue acting - why not?
According to the regulations, the Minister of Health is responsible for approving the plan. The Minister of Finance is only a partner in the agreement. That is - if the plan was not signed, it was not because the Minister of Finance did not agree, but because the head of the Ministry of Health did not risk signing.
The lack of approval does not entail legal consequences for service providers. It does not stop the activities of the National Health Fund. But it limits the possibility of maneuver and development. And ultimately - someone is responsible for this. And it will be the Minister of Health.
The whole situation is a bit like a plane flight, where the autopilot system works perfectly, but no one has access to the cockpit. We are flying, but we don't really know where. What's more, there is not much you can do to change course. And if turbulence appears, there will be a problem.
Polish healthcare operates without an approved financial plan. Legally, systematically, calmly. But this is not normal. This is a legal exception. Temporariness built on routine.
Now it will be as usual. Maybe the plan will be signed, or maybe it will fly by the end of the year in the "CEO version" mode. The patient won't notice anything. The hospital - maybe they will feel something if the situation becomes dynamic. The Minister of Health - will finally have to sign something. Or not.
After all, in this country, no one asks "does something work?" anymore, but "has anyone signed it?" And increasingly, the answer is "no, but it works."
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