Doctors, nurses, and midwives have just secured pay raises. At the same time, however, limits in healthcare – previously abolished by Law and Justice (PiS) – are being quietly reintroduced through the back door. Gazeta Wyborcza states outright that this is the result of a meeting between the Minister of Health, top officials of the National Health Fund (NFZ), and Prime Minister Donald Tusk. Experts are already warning that funding will fall short for a wide range of services – and for many patients.
After a long struggle, medical staff can celebrate a victory. Although the Ministry of Health wanted to freeze the July pay rises, doctors and nurses prevailed: this summer, salaries for both medical and non-medical personnel will increase by 8.82 percent. According to available data, from July 1 the minimum salary of a specialist doctor will reach PLN 12,900. A pharmacist, physiotherapist, or nurse with a master’s degree and specialization will earn PLN 11,400, while a medical caregiver will earn just under PLN 7,600. The Agency for Health Technology Assessment and Tariff System estimates that the raises could cost around PLN 7 billion annually. The ministry was keen to cut costs at the expense of medical workers, but pressure from staff proved too strong: during a recent session of the Tripartite Team for Healthcare, no agreement was reached on changes to the so-called pay-rise act. Not only doctors were determined – trade unions of nurses and midwives made it clear they were ready for decisive protest action. In a pre-election climate, this would have posed a serious image problem for the ruling camp, increasingly concerned about losing power. And since opinion polls now appear to be the government’s primary concern, the ministry led by Jolanta Sobierańska-Grenda backed down.
A Downward Spiral in Healthcare
I have been dealing with public healthcare for too long to start shouting, “hurr, durr, selfish medics are draining money from an increasingly impoverished budget”. First, one should ask why the state budget is becoming weaker. That is a question for those currently governing us – and they will answer it sooner or later by losing power. Second, if we want to maintain even a modest but functioning medical workforce in Poland, we cannot change the rules of the system mid-game – especially at such a critical moment. Pay up, Minister. Third, during its eight years in power, Law and Justice (PiS) managed to allocate increasing funds to public healthcare. The then opposition complained it was not enough – but these are the same people who are now starving medical institutions and patients. Quite literally, as the PiS program “Good Meal” has effectively been scrapped.
As an aside, I found it amusing when even liberal media – usually eager to favor doctors – began suggesting a few months ago that some people in healthcare might be earning too much. Amusing, not surprising – every tactic is allowed when defending the power of Donald Tusk.
The real drama – indeed tragedy – lies elsewhere. On Wednesday, Codzienna published my brief commentary, “Down the Slippery Slope in Healthcare,” devoted to this issue. On one hand, pay raises for staff; on the other, growing cuts affecting hospitals and patients. This is pragmatism turning into cynicism. Pregnant women and the chronically ill will not set up protest camps outside the Prime Minister’s Office. And even if they tried, the authorities would likely send not only the police, but also shouting activists from various “defense committees,” fueled by beetroot juice.
Let us return to the core issue. In February, the Ministry of Health proposed a devil’s bargain to hospitals: under a government regulation adopted at the time, if a hospital shuts down specific “unprofitable” departments, it will receive funding for 50 percent of the services provided in the year prior to closure for the next two settlement periods. The idea angered doctors and experts, who stressed that decisions to close departments must be monitored and ensure patient safety. The proposed mechanism, however, could lead to irrational decisions to shut down entire units.
PiS Abolished Limits. Now They Are Coming Back
The scale of destruction has already become so significant that in early March, doctors and local government officials jointly organized a protest in Warsaw. The “Let’s Save County Hospitals” initiative gathered hospital directors from the National Association of County Hospital Employers and representatives of the Association of Polish Counties outside the Ministry of Health headquarters. Let us be clear: both groups can read the signs. They know they are fighting not only for patients, but for their businesses, jobs, cities, and regions. The collapse of county hospitals means civilizational decline – leading inevitably to depopulation, lower tax revenues, and diminishing attractiveness of entire areas. Yes, it is a slippery slope.
Anyone who thinks this is the end of bad news is mistaken. Under the “smiling” government, there seems to be no end in sight. One wonders whether Donald Tusk, when he met with the Minister of Health and NFZ leadership on March 9, had a white-and-red heart pinned to his jacket. The topic was far from trivial: limits in healthcare are returning. Confetti and fanfare!
This is no exaggeration – Gazeta Wyborcza reports: “Following the prime minister’s ‘summons,’ the NFZ wants to drastically limit the number of gastroscopies, colonoscopies, CT scans, MRI scans, and soon also specialist consultations. The ‘rationalization’ of spending will not apply only to children and cancer patients.” Officially, no one calls this “limits,” but industry portals have no doubts. Termedia.pl writes: “The leadership of the National Health Fund intends to partially restore limits in financing outpatient specialist care services,” while Ochronazdrowia.mp.pl explains: “If measures discouraging the provision of services are introduced, one cannot expect their number not to fall; we are dealing with the restoration of limits, even if they are called something else.”
“Inequalities Will Grow”
For the record, limits on financing outpatient specialist services were abolished in July 2021 by the government of the United Right. The current NFZ leadership now plans to pay only 40 percent of the previous rate for so-called excess services. Decision-makers argue that no harm will be done, claiming “PiS generosity did little for patients.” Yet even TVN quotes outraged experts and patient organizations, who fear the return of long waiting times for diagnostic tests – just as before the limits were lifted.
It is telling that these “smiling limits,” introduced without hesitation after the prime minister’s intervention, are criticized by Wojciech Wiśniewski from the Federation of Polish Entrepreneurs: “All such savings lead to reduced patient access to services. Over the course of the year, the situation will deteriorate, especially toward the end. I am also concerned that health inequalities will increase. Wealthier individuals will likely turn to the private sector, but millions of Poles cannot afford to spend hundreds or even thousands of zlotys on tests.”
Heads of medical institutions add more: this is not only about restoring limits – the law will apply retroactively, as excess services will be counted from January. Is there any method to this madness? Some patients, if they survive, will notice the consequences only after months or even years. By then, someone entirely different may be governing Poland. Donald Tusk might then travel to Pułtusk and shed tears over patients wronged by the right. Unfortunately, public memory is short.
This entire situation reveals the cynicism of the current government, which, when under pressure, can yield to wage demands from healthcare workers, while simultaneously starving the system and seeking savings at the expense of hospitals and patients. You wanted a “smiling” government? Well, here it is. It is just a pity that the easiest place to encounter it may be a cemetery.