Poland’s healthcare system is in deep financial trouble, with the National Health Fund (NFZ) facing a deficit estimated at between 23 and 60 billion zlotys this year. The government has revealed a plan to raise excise duties on alcohol and sugar, combined with a new mechanism that would channel any surplus revenues above a fixed threshold directly to the NFZ. Critics say the scheme is more about political optics than solving the funding crisis.
Hospitals are closing maternity wards, limiting diagnostics, and reporting unpaid bills for extra procedures. The NFZ’s planned revenue for 2026 stands at around 217.4 billion zlotys, but experts from employers’ organizations estimate the gap at a minimum of 23 billion zlotys, with more expansive scenarios pointing to 50–60 billion. The government’s answer, unveiled by Finance Minister Andrzej Domański at the European Financial Congress in Sopot in June 2026, is to revive tax hikes that were previously blocked by the president.
– We will return to projects that were stopped, like higher excise on alcohol or the sugar fee – said Andrzej Domański, stressing that the goal is to increase the state’s fiscal space to fund growing expenses, including healthcare.
The surplus mechanism and its limits
A bill re-introduced to parliament proposes a 15% increase in alcohol excise this year and a further 10% in 2027. The key innovation is a “surplus mechanism”: all excise revenues above 14.7 billion zlotys would be automatically transferred to the NFZ. Currently, alcohol excise brings in about 15–16 billion zlotys annually, meaning the actual transfer to the health fund would amount to only 0.5–3 billion zlotys per year. That is a fraction of the deficit.
Jan Sarnowski, former deputy finance minister and tax partner at Fieldfisher Poland, poured cold water on the idea. – The scale of the problem is gigantic. Completely different solutions are needed – he said. Sarnowski noted that even multi-year excise increases would generate marginal effects. He pointed out that the VAT gap in Poland in 2023 was about 16%, which at projected 2026 revenues of 341.5 billion zlotys implies a potential loss of around 65 billion zlotys. – Improving tax collection, especially fighting organized crime, offers more fiscal potential than raising rates – he argued.
Structural problems behind the deficit
Professor Monika Raulinajtys-Grzybek from the Warsaw School of Economics (SGH) stressed that the NFZ’s funding gap is multi-causal. On the expenditure side, the system has expanded: more advanced technologies, lifted co-payments for some drugs, and relaxed limits on procedures. On the revenue side, contributions from agriculture (KRUS) are heavily subsidized by the state budget, and some business forms enjoy lower effective health contributions than standard employment. Demographics add pressure: an aging population reduces the contribution base while raising costs.
– Without decisions on the revenue side, the deficit will grow structurally from tens to potentially hundreds of billions of zlotys – warned Raulinajtys-Grzybek. She compared Poland’s health contribution rate of roughly 9% with higher rates elsewhere: Germany 14–16%, Slovakia 15%, Croatia 16%, and the Czech Republic 13%, all with a more uniform base. Current contributions cover only about two-thirds of healthcare costs, she estimated.
The government’s political gamble is clear: by tying extra healthcare funding to excise revenues, any presidential veto can be framed as blocking money for patients. But experts remain skeptical that a few billion zlotys from alcohol and sugar taxes can fix a system that requires deep, structural reform.
Źródło: WNP.PL, Fot. Alexandros Michailidis / Shutterstock
