Poland’s healthcare system is bleeding cash. With the National Health Fund (NFZ) facing a gap estimated at 23 to 60 billion zlotys in 2026, the government is returning to plans for higher excise taxes on alcohol and an expanded sugar tax. The key innovation is a 'surplus mechanism’ that would channel any extra revenue above a 14.7 billion zloty threshold directly to the NFZ – a move experts say is designed as much to corner the president into accepting the hikes as to actually fix the funding crisis.
The scale of the problem is staggering. Hospital wards are closing, diagnostics are being rationed, and providers are not being paid for procedures they have already performed. While nominal spending on health has risen, it has not translated into shorter waiting lists or better access. The NFZ’s planned revenue of about 217.4 billion zloty falls at least 23 billion zloty short of estimated needs, according to employers’ organisations, with some forecasts putting the gap as high as 50–60 billion.
Finance Minister Andrzej Domański announced at the European Financial Congress in Sopot that the government would revive previously vetoed fiscal projects. 'We will return to projects that were stopped, such as higher excise tax on alcohol or the sugar tax,’ he said, stressing the goal was to increase the state’s fiscal space to cover growing spending, including on healthcare.
The surplus mechanism – a political golden bullet?
The government has reintroduced a bill to parliament that would raise alcohol excise rates by 15% in 2026 and by another 10% in 2027. A new 'surplus mechanism’ stipulates that revenues above the threshold of 14.7 billion zloty (split between different alcohol categories) would be automatically transferred to the NFZ. That means the Fund would only see extra cash if consumption holds up or grows. Under realistic scenarios, the transfer would amount to between a few hundred million and perhaps 3 billion zloty annually – a fraction of what is needed.
– Even with multi-year excise increases, the fiscal effect is marginal in the scale of the system – said Jan Sarnowski, former deputy finance minister and tax advisor at Fieldfisher Poland. He pointed out that the earlier excise hike project would yield only about 1.8 billion zloty in 2026 and 2.8 billion annually thereafter. 'That is a drop in the ocean of the NFZ’s needs,’ he added. Sarnowski argued that closing the VAT gap – estimated by the European Commission at around 16% in 2023, representing a potential loss of some 65 billion zloty – would offer far greater fiscal potential than raising excise rates.
Politically, however, the mechanism is clever. Any presidential veto can be framed as blocking money for children, seniors, or drug programmes, raising the political cost of rejecting the tax hikes. In the most optimistic scenario, extending this model to several consumption taxes could generate an extra 2–5 billion zloty for the NFZ – still far below the financing gap.
Structural deficiencies in health financing
Professor Monika Raulinajtys-Grzybek of the SGH Warsaw School of Economics pointed to multiple factors deepening the NFZ’s deficit. On the spending side, access to modern medical technologies has been widened, copayments for some drugs have been abolished, and limits on services have been lifted – all increasing volumes. On the revenue side, the health insurance contribution has not been systematically raised despite growing costs, and many groups remain outside the full contribution system.
– The state still maintains exceptions. For example, the Farmers’ Social Insurance Fund (KRUS) will pay about 4.5 billion zloty in health contributions this year, but the vast majority of that sum will be subsidised by the state budget, not by the farmers themselves – she said. She also noted that certain forms of business activity allow for lower effective contribution rates than standard employment contracts.
Demographic pressures are mounting: a growing share of elderly people reduces the contribution base while increasing treatment costs. At the same time, costs have been shifted from the state budget to the NFZ without securing additional funding. In the worst-case scenario, the deficit could escalate from tens to hundreds of billions of zloty, changing the nature of the problem from a budgetary one to a systemic crisis. 'If no decisions are made on the revenue side, the NFZ deficit will snowball,’ warned professor Raulinajtys-Grzybek.
Źródło: wnp.pl, Fot. Shutterstock
