The past 2022 has brought several changes in hospital financing. The beginning turned out to be the introduction on July 1 of raises for employees of medical facilities and the way they are financed – that is, an increase in the valuation of services. Immediately, differences between facilities became apparent, resulting in the emergence of relief and recovery mechanisms for units that not only lacked enough for raises, but also for ongoing operations.
One of the key events of 2022 in health care is undoubtedly the revolution of the
in the budget of the National Health Fund, which will take over the financing of services that were previously the responsibility of the Ministry of Health. As of January 1, in accordance with an amendment to the Law on the Profession of Physician and Dentist and Certain Other Laws, the financing of some health services is being transferred from the state budget to the Fund. This includes for highly specialized services, emergency medical teams, financing the purchase of free 75 plus drugs and for pregnant women. Under the new regulations, the Fund is also taking over the financing of the purchase of vaccines used for mandatory vaccinations under the immunization program. According to experts, this will deplete the NFZ budget by PLN 13 billion in 2023 alone.
2022 also included 7 laws that were supposed to heal the system. One has been implemented – on minimum wages. Announced back in the fall of 2021. The bill on the National Oncology Network still has not reached the Parliament. According to the latest announcements made by Health Minister Adam Niedzielski, the law will come into force from the second quarter of 2023 at the latest.
A new draft law on hospital reform (the draft law on modernizing and improving hospital efficiency) is expected to be published and sent for consultation, but not until January 2023. The first draft of this law was presented by the Health Minister on December 30, 2021. The government planned to adopt it in the first quarter of 2022, and it was to be sent to the Parliament shortly thereafter. However, the draft faced many comments from local governments and hospital managers and was amended several times.
The beginning of 2023 marks the continuation of changes. The first of these – a new network of hospitals. As of January 1, 2023. the second list of network hospitals is in effect, which is expected to remain valid until June 30, 2027. and includes 585 facilities (there were 592 in the previous one).
A significant change for hospitals will be the announced final adjustment of valuations of services in internal medicine, which will not be an increase in all ranges. In some benefits, a reduction in valuations is expected. Moreover, according to analysts, the introduction of new valuations of internal medicine will not improve the situation of city or county hospitals, if valuations of, for example, general surgery or gynecology and obstetrics do not change.
In 2022, total outlays on health care accounted for 5.75 percent. GDP, in 2023 they will be at least 6 percent. GDP, and by 2027 this figure is expected to rise to 7 percent. Gross Domestic Product. Outlays in 2023, according to current financial plans and the draft state budget, will amount to almost 165 billion zlotys, which would give as much as 6.3 percent. GDP.
As recently as November, the Health Ministry announced that as of January 1, 2023, the flat-rate point valuation would increase by 15 percent to PLN 1.62. When a new billing year begins, before contracts are changed, hospitals settle based on the average price from the previous year. Indeed, the Health Ministry is raising the lump sum by 15 percent over the average annual price, but de facto it raises little over the price in effect from July 2022. Experts note that if the increase in the flat-rate valuation were really 15 percent, then, calculating from PLN 1.59, it should be PLN 1.82 as of January.
According to preliminary analyses, medical facilities are facing an increase in debt in the sector this year. The Minister of Health reassures that runoffs from health premiums are increasing as salary levels rise. However, inflation is rising even faster, and with it, hospitals’ expenses for drugs, electricity, gas and services such as cleaning and feeding patients. Hospitals in order not to suspend work in more departments will be forced to offer competitive salaries to white staff compared to other units.
Hospital executives also predict that medical facilities face even more debt. They are already not shying away from borrowing from parabanks. Calculations by the Association of County Hospitals of the Silesian Voivodeship show that more than one hospital has to contribute more than PLN 830 thousand a month. PLN, of which 350 thous. PLN are raises only for white staff employed under labor contracts, and more than 100 thousand. PLN for administration.
In May, a new, higher valuation of services, from which salaries are currently funded in full, is due. County hospitals, which did not bear the increases last year, are worried that it will be inadequate again. Especially since the agency in charge of valuation (AOTMiT), does not disclose the methodology used.
