Poland has made significant progress in improving the health of its citizens, but health outcomes still lag behind most OECD countries. Healthcare services are widely available, although healthcare costs for patients are not fully covered by the public system, which puts poorer households at risk. While Poland’s spending on healthcare has been relatively low, rationalising excess capacity in the hospital system and making more use of incentives in primary care would raise efficiency and improve care. However, to provide better healthcare services on a sustainable basis, it will be important to continue to boost the relatively low numbers of nurses. Moreover, improvements to treatment and a greater focus on prevention, particularly related to health risks around tobacco and alcohol use, could significantly improve health. The government is raising spending to meet rising demand and improve health outcomes. It has mostly focused additional resources on boosting the workforce, but further increases in spending should focus on a specific range of health measures and be more closely linked to efficiency savings. Pressures from the ageing population will remain and long-term care needs to be expanded in a sustainable way.
OECD Economic Surveys: Poland 2025
Abstract
Poland has made progress in improving health outcomes over the past two decades. Life expectancy at birth rose by 4.2 years between 2000 and 2019 to 78 years (Figure 2.1), mostly driven by large declines in mortality from cardiovascular disease. Life expectancy fell sharply in 2021 due to COVID-19 but recovered to 78.6 years in 2023. This is the highest in Polish history but below the OECD average. People in Poland can expect to live longer and spend their older years in better health than most of their Central and Eastern European and Baltic peers, but Poland still lags behind the majority of OECD countries. Health outcomes tend to be worse for people on low incomes and men. Around 4% of the population report unmet needs, above the OECD average.
Life expectancy at birth
Source: OECD Health Statistics.
Almost half of all deaths are due to circulatory system disease, such as ischaemic heart diseases, hypertension and stroke. These diseases are 50% more prevalent than the OECD average (Figure 2.2). Cancer contributes to around a fifth of all deaths, and the cancer mortality rate is higher than the OECD average. Treatable mortality, deaths that could be avoided through earlier detection and treatment, are relatively high for circulatory diseases. Moreover, over two fifths of all deaths are related to smoking, alcohol consumption, and low physical activity, and could be reduced through better public health programmes that address these behavioural risk factors, (OECD, 2023b).
Death rates per 100 000 population (age-standardised), 2022 or latest available
Note: External causes of death include accidents, suicides, homicides, and other causes.
Source: OECD Health Statistics.
The pandemic took a significant toll on health and highlighted the limitations of the healthcare system. COVID-19 infections directly increased deaths among the population and Poland was affected more than most OECD countries (Box 2.1). However, the pandemic also indirectly worsened health outcomes as treatments were postponed and participation in cancer screening dropped. Deaths due to other causes also rose. The healthcare system was put under strain and showed several limitations. Despite large hospital capacity, it was difficult to scale up healthcare services partly due to pre-existing staff shortages. Poland’s progress on digitalising healthcare services illustrated how more digital and better coordinated health systems could provide more resilience during a pandemic.
To boost health outcomes, Poland should continue to pursue a comprehensive approach to reforming the healthcare system. The ‘Healthy Future’ strategy sets out a range of goals to improve health and the Polish government is planning to further increase funding for healthcare. Higher funding should be directed to priority areas and go hand-in-hand with measures to improve working practices and reduce costs. This chapter explores key aspects of the healthcare system where increasing funding and boosting efficiency can support achieving these goals. Section 2 looks at how healthcare coverage and financial protection can be improved. Section 3 discusses how existing resources could be more efficiently managed, while Section 4 presents policy options to tackle staff shortages. Section 5 looks at ways to improve treatment and prevention to boost health outcomes, while Section 6 considers the financing of the healthcare system and expanding long-term care.
The initial wave of COVID-19 infections in early 2020 was effectively contained with a strict lockdown. The lockdown was progressively relaxed from the end of April and, with few restrictions over the summer, COVID-19 cases started rising again. This was met with localised restrictions and eventually a national lockdown as cases peaked in November 2020. Restrictions were subsequently eased more gradually, and a softer lockdown was implemented during a second and stronger wave in the spring of 2021. As vaccination rates picked up, restrictions became less stringent over the summer, but they remained in place until 2022 when they were further relaxed. However, progress on vaccination slowed considerably by 2023 as people were more hesitant to get a booster.
Poland was affected by the pandemic to a greater extent than many other countries. Between 2020 and 2022, the number of deaths directly attributable to COVID-19 was higher than in most OECD countries (Figure 2.3). Vaccination rates were below the EU average in 2022, particularly among older people. Poland’s large hospital capacity helped absorb more serious cases, although pre-existing staff shortages made it difficult to scale up healthcare services during the pandemic. This led to suspensions in elective care and volumes of surgical procedures fell. Participation in cancer screening also declined sharply. However, rapid digitalisation allowed some services to remain available.
Note: According to WHO guidelines, a “COVID-19 death is defined for surveillance purposes as a death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID-19 disease (e.g. trauma)”. Separate codes were issued for cause of death by testing or by clinical or epidemiological diagnosis. COVID-19 deaths figures presented here account for the combined years 2020 to 2022 and are subsequently converted into rates per 100 000 population using 2021 population data from the United Nations 2022 Revision of World Population Prospects. For more details, please see OECD (2023a).
Source: OECD Health at a Glance 2023 , OECD (2023b).
The Polish healthcare system is built around public health insurance with broad coverage across the population that funds, among other things, primary care, hospital care, and long-term care. The funding of the system is relatively centralised, while the provision of healthcare is organised at different levels of government (Box 2.2). Poland spent an estimated 7.0% of GDP on healthcare in 2023, among the lowest shares in the OECD, although spending has increased substantially in recent years. In the past, around three quarters of spending has been financed publicly. The rest is financed privately through voluntary healthcare insurance, accounting for 7-8%, and out-of-pocket spending that has normally made up just under 20% of spending on healthcare.
The Constitution of the Republic of Poland gives all citizens the right to equal health services financed from public funds and guarantees the right to health to protection as a human right. Healthcare legislation is the responsibility of the Parliament which, with the support of the Supreme Audit Office, also holds the government accountable. The Council of Ministers, in cooperation with other ministries, is responsible for developing the National Health Strategy. The Ministry of Health issues further executive regulations for the healthcare sector, such as defining the benefits basket while the local authorities directly regulate some of the local health care providers.
The main aspects of the Polish healthcare system operations are relatively centralised. The Ministry of Health is in charge of health sector governance and its organisation. At the central level, the Ministry is responsible for financing, which is implemented by the National Health Fund. The Ministry establishes the statutory basket of benefits supported by the Agency for Health Technology Assessment and Tariff System. The National Institute of Public Health helps the Ministry form national health policy. The Ministry is also responsible for healthcare workforce planning. The E-Health Centre supports the digitalisation of healthcare, while the Centre for Monitoring Quality in Health Care monitors quality of healthcare services and organises accreditation and training. The Chief Sanitary Inspectorate and the State Pharmaceutical Inspection ensure compliance in healthcare and pharmaceutical markets.
The Ministry interacts with multiple layers of government to implement healthcare services. On a national level, the Ministry of Health consults with other ministries, as well as professional chambers, on the education on medical staff. On a regional level, the Ministry consults with representatives from Polish regions (voivode) on health services and professional education.
The National Health Fund delegates the purchasing of healthcare services to its 16 regional branches with budgets reflecting the size and composition of the population and its health needs. The voivodes are mainly responsible for health promotion and prevention, particularly in occupational medicine, mental health and addiction services.
The organisation, governance and monitoring of healthcare is delegated according to levels of complexity. The Ministry of Health is responsible for university hospitals and clinics, and the National Health Fund organises primary care at the national level. The voivodes own and operate larger hospitals while the counties (powiats) own and run smaller hospitals with basic specialties. Municipalities (gminas) organise prevention programmes for local areas.
Source: Sowada et al, 2019.
Public insurance coverage of health services is almost universal (Box 2.3). Insurance is mandatory for workers and pensioners while others can be covered as co-insured family members living in the same household. The state provides insurance for many groups, such as the long-term unemployed, and children and pregnant women are given full access to public healthcare. Poland has also provided healthcare for 1.2 million Ukrainian refugees since February 2022, including mental healthcare, and reimbursed medicines on similar terms available to Polish citizens (OECD, 2023b). Overall, around 96.9% of the resident population is covered by public health insurance with most of those not covered estimated to live abroad without having deregistered in Poland (Sowada et al, 2019).
While public health insurance provides access to a range of healthcare services, it does not fully cover the cost of those services. In 2023, there has been a significant expansion of coverage for medicines for the young and older people (see below). The overall public financial coverage of healthcare costs in 2022, and prior to recent changes, stood at 74% of total health spending, similar to Hungary but below Czechia and Slovakia. The share varied by type of care. Coverage of hospital care costs is high, but outpatient medical care coverage is below the OECD average. Dental care costs were covered to a lower extent than in most other Central and Eastern European countries. Financial coverage of medicines was only 34% in 2022, well below the OECD average (Figure 2.4). The partial coverage of healthcare costs led to significant out-of-pocket spending. In 2022, households paid for 18.8% of all healthcare costs out of their own pocket, accounting for 1.2% of GDP, around the OECD average of 18.5%. The majority of out-of-pocket spending was due to medicines and medical devices. Long waiting times and unmet health needs have led people to pay for private dentistry and outpatient health services.
Public healthcare services are comprehensive and statutory health insurance offers broad financial coverage. Publicly funded healthcare services can be provided by either the public or private sector, and many are free. For example, primary and secondary healthcare including emergency care, is free at the point of use. Palliative care is also free. Prescribed medicines are reimbursed to a certain extent although a wide range is free for those aged under 18 and 65 years and older. Medicines provided in inpatient settings and those taken regularly are fully covered by public health insurance. While private voluntary health insurance and subscription packages can be purchased by anyone, they are often bought by companies to provide additional employee benefits and they tend to facilitate faster access to health care services, mostly for specialists.
Primary healthcare is provided mainly by individual or small groups of private practitioners who offer preventive and curative services, assessments, screening and diagnostics, and vaccinations. They act as gate keepers since patients have to obtain a referral to access most specialist care. Night and holiday care is provided by on-call physicians and in hospital emergency wards.
Secondary care is offered by specialised ambulatory care providers, which are predominantly private, and hospitals, which are mostly publicly owned. Both primary and secondary care is free. Long-term care is provided by both health and social insurance, and in both health and social sectors the number of places in residential care homes is limited. Day care is available, although most long-term care is done by family members (Figure 2.33). While publicly insured dental healthcare is widely accessible at predominantly private dentistry practices and covers a range of dental services, only a small share of dental costs is covered.
Government and compulsory insurance spending as a proportion of total health spending by type of care, 2022 or latest year available
Note: Healthcare coverage is defined by the share of the population entitled to services, the range of services included in a benefit package and the proportion of costs covered by government schemes and compulsory insurance schemes. Hospital care refers to inpatient curative and rehabilitative care (which is mainly provided in hospitals); outpatient medical care to all outpatient curative and rehabilitative care excluding dental care; and pharmaceuticals to prescribed and over-the-counter medicines, including medical non-durables. The OECD32 average does not include Colombia, Costa Rica, Mexico, New Zealand, Türkiye and the United States.
Source: OECD Health Statistics.
Out-of-pocket spending has been widespread among households and has caused some to experience financial difficulties. In 2019, 8.6% of all households experienced catastrophic health spending, where payments exceed 40% of household income. Around two thirds of those households were among the poorest 20% in Poland. This had risen to 9.4% in 2021. Particularly affected are households on social benefits, large families, households comprising members with disabilities, and pensioners. Catastrophic spending is predominantly driven by high spending on medicines. Many of those are over-the-counter medicines. This could be related to difficulties in healthcare access.
Financial protection mechanisms for households facing high healthcare costs have been substantially extended for the young and the old in 2023, but they remain limited for working people on low incomes and are not targeted. Those aged 75 years and older have been exempt from co-payment for most medicines since 2016. As of September 2023, the exemptions have been broadened to all people aged 65 years and older, as well as children under the age of 18. The list of free medicines currently covers 90% of prescription medicines, which has boosted financial protection for these groups. The expansion of publicly-funded dental care benefits, albeit from a low base, has also helped. However, these changes do not cover those working age people on low incomes. Local authorities, depending on their financial capacity, can contribute to the costs of medicine or treatment for people receiving income support. However, financial protection mechanisms are not explicitly linked to income and there are no caps on the co-payments for medicines and medical products.
To further reduce poverty risks related to high out-of-pocket spending and improve public health, financial protection should be strengthened and targeted towards households at risk. Policy should now focus on the reimbursement of medicines for people with low incomes or chronic conditions. Co-payments are required for prescription medicines based on the percentage of the price with no limit on co-payments, although fixed co-payments are applied to medicines prescribed for regular and prolonged use. There are no exemptions that explicitly benefit poor households and people with chronic conditions. Poland should bolster financial support for prescription medicines and partly contribute to the purchase of non-prescription medicines. For example, Estonia’s reforms in 2018 lowered the eligibility threshold for qualifying for co-payments from EUR 300 to EUR 100, with the benefit automatically applied when patients purchase medicines. Although there is no cap on co-payments, this has lowered out-of-pocket spending in Estonia and reduced the risk of impoverishment (OECD, 2024c). In Poland, the Reimbursement Act has been revised to reimburse some long-term over-the-counter medicines from 2023 onwards. Limiting co-payments for households in the bottom quintile of the income distribution in order to avoid catastrophic spending could cost around 0.3% of GDP.
Poland achieves satisfactory health outcomes given the low level of spending. Life expectancy has increased by 2.5 years between 2008 and 2019 as avoidable mortality has fallen by a fifth over the same period. At the same time, total spending on healthcare in purchasing power parity terms has risen by 50%, although it has been broadly constant as a share of GDP and comparatively low at around 6.4% on average. To improve efficiency, Poland has taken specific actions, such as introducing the Agency for Health Technology Assessment and Tariff Systems in 2015 which plays a stronger role than in many other European countries in determining the basket of benefits and setting tariffs. New health programmes and investments are subject to evaluation that aims to ensure that they are efficient and tailored to the health needs of local populations (Sowada et al, 2019). Furthermore, markets for pharmaceuticals are fairly liberal, which has made medicines widely available and less expensive than in other countries.
While it is difficult to measure the efficiency of the health system, Poland achieves higher life expectancy than Hungary and Lithuania while spending similar amounts or less, but other countries, such as Greece and Chile, have similar health spending and higher life expectancies (Figure 2.5). A recent OECD study by Dutu and Sicari (2020) uses a non-parametric technique to estimate a frontier of countries’ health spending performance that controls for a range of determinants such as spending, socio-economic and lifestyle factors. Although subject to uncertainty, this analysis suggests that the potential for Poland to raise life expectancy without further increasing spending is greater than in some other OECD countries. While this may not be easy to achieve, many of the treatment and prevention measures recommended in Section 2.5 would boost efficiency at little additional cost. Reforms to primary healthcare and hospitals can help make greater use of existing resources, while digitalisation has the potential to boost efficiency further.
Total healthcare spending as a share of GDP
Note: The shaded area highlights countries with levels of health spending per capita that are relatively close to Poland’s spending levels.
Source: OECD Health Statistics.
Making more use of financial incentives in primary and specialist care
Primary healthcare is the main entry point to the Polish healthcare system. Primary healthcare services cover diagnostics, treatment, and nursing, as well as health promotion and disease prevention. Family doctors serve as gatekeepers, as patients usually have to obtain a referral before accessing specialist care. However, high workloads and a relatively strong reliance on capitation fees have incentivised family doctors to conduct fewer diagnostics and refer patients to more expensive specialists, reducing their gatekeeping role.
Family doctors have predominantly been compensated on a capitation basis (Box 2.4). However, performance-related compensation can drive higher efficiency of healthcare provision. For example, it has improved health and lowered costs in Estonia (Lai et al, 2015). The use of financial incentives within primary healthcare is relatively low, although it is increasing. From 2022, family doctors in Poland have had dedicated diagnostic budgets that allow them to order additional tests from a specific list. In addition, incentive allowances have been introduced since mid-2022 to boost prevention. However, the incentives are not directly related to improvements in patients’ health outcomes and only make up around 2% of family doctors’ incomes. In some OECD countries, they account for 5% to 20% of pay. In the United Kingdom, up to 10% of GP practice income comes from incentive payments in the quality and outcomes framework; in Türkiye, around 20% of primary care provider salaries are incentive payments.
By contrast, specialists are mostly compensated on a fee-for-service basis. Compared to capitation payments, which can lead to under-provision of healthcare services, fees reward activity but do not provide effective incentives for doctors to work efficiently and can lead to overprovision. As the limits on visits to specialists were removed in 2021 and public funding rose in 2024, there was a marked increase in the number of visits per patient with little overall improvement in waiting times. Limits on visits to specialists funded by public insurance should be restored. Furthermore, specialist payment mechanisms could be reviewed. A blended model of fixed and variable payments could potentially boost efficiency without adversely affecting health outcomes. Bonuses and awards that reward efficiency on a per capita basis could also raise efficiency, with incentives higher in regions where waiting times are longer. For example, in October 2024 waiting times for cardiologists’ appointments varied nationally between 99 and 434 days.
Primary care services are mostly paid for by annual capitation payments. Family doctors receive capitation payments for each patient on their list that adjusted for patient age. Since 2017, aspects of performance-based payments have been introduced. There is a bundled payment for providing coordinated care, a special activity-based budget for providing preventive care, separate budgets for diagnostic and specialist ambulatory care, as well as elements of incentive pay depending on treatment outcomes and quality of provided care. Nurses also receive annual capitation payments with higher payments for children, older people and people in social assistance homes.
Specialist care is remunerated on a fee-for-service basis with the level of payments depending on the services provided during the visit. Services and payments can also be case-based and related to the diagnosis-related group system (DRG). There are some aspects of pay-for-performance for coordinated care.
Acute hospital care, including specialist care in outpatient hospital departments, is also based on DRG payments since 2008. The hospital network established in 2017 introduced new biannual lump sum payments. These are made for complex care provision, which covers most hospital and outpatient specialist services. This allows for more flexible management of financial resources than DRGs. Non-complex care is financed via DRGs. Some services, such as chemotherapy, are paid for on a fee-for-service basis. The size of lump sum funding is partly related to good performance and higher care quality, while pay-for-performance payments are used for coordinated care.
Emergency medical care is financed by a lump sum payment to cover fixed of costs of running a department and by per diem fees for patients. Dental care is charged as a fee for each service provided. Within long-term care, residential care services are paid per day with regional governments contributing with lump sum payments. Home care is paid for on a fee-for service basis.
Source: Sowada et al (2019; 2022).
User charges can contribute towards more efficient use of healthcare services while avoiding additional pressure on financially vulnerable households. People in Poland see their doctors more often than in many other OECD countries (Figure 2.6) and there are no charges for consultations within primary and specialist healthcare. There are no limits on the number of visits to specialists and there is no cost to cancelling or missing an appointment. This contributes to additional demand for healthcare services and long waiting lists. Introducing a small user charge for certain groups might not meaningfully reduce access to healthcare but could reduce unnecessary visits and improve use of medical resources without undermining access to healthcare. While equal access to publicly funded health services is guaranteed by the constitution, this has not prevented introducing similar charges in other OECD countries, such as Czechia. Moreover, there could be a small fee to be paid for last-minute cancellations and missed appointments. The use of private healthcare services in Poland already demonstrates willingness to pay. However, survey evidence suggests that Poles are opposed to paying for existing public services without any improvement in quality or access (Tambor, 2018). To maximise public acceptance, a small fee could be introduced alongside better or new services, such as a reduction in waiting times. Exemptions to any fee should be made for children, those on low incomes and with chronic health conditions, to avoid unduly limiting access. While a low fee with exemptions would raise only modest revenue, user charges should help free up some resources within primary and specialist healthcare by changing behaviour and encouraging more efficient use of doctors’ time. Additional measures such as using teleconsultations for prescription renewals or offering basic health advice through an app, as in Estonia, could further raise efficiency.
Annual doctor consultations per person
Note: 1. Latest data available from 2021.
Source: OECD Health Statistics.
Poland is expanding its use of integrated care, which is designed to provide better care to patients and links primary and hospital care more closely. Integrated care systems bring together different healthcare providers in joint treatment of a patient’s health condition. There is evidence that it improves health outcomes and reduces costs in the medium- to long-term (Baxter et al 2018; Timpel et al 2020). Poland has piloted the ‘PHC Plus’ programme that provided comprehensive and coordinated care for adults eligible for prevention programs, people with multiple chronic conditions and/or complex needs, and other vulnerable populations. The pilot programme was implemented between July 2018 and September 2021, covering 47 primary healthcare facilities and 71 000 participating patients. The results were encouraging. An evaluation of the programme pointed to improved patient-reported health outcomes and satisfaction (WB, 2021a). But, it also highlighted the need for additional resources, such as care coordinators, to help manage the higher workload, as well as the importance of bundled payments to drive better healthcare. This helped pave the way to introducing coordinated care.
Since late 2022, the Ministry of Health has been rolling out coordinated care within primary healthcare nationwide, but on a voluntary basis. The areas covered are cardiology, diabetology, pulmonology, endocrinology, and nephrology. Participating healthcare providers are given improved access to diagnostics and specialist consultations, as well as more resources for disease prevention and health promotion. By September 2024, 37% of all primary healthcare practices - covering just under half of the population - offered coordinated care. Many more practices wanted to participate but experienced difficulties in finding specialist clinics to cooperate with. For smaller practices, the lack of additional staff resources also proved an obstacle (KLRP, 2024). The National Health Fund should provide family doctors with lists of interested specialists to facilitate cooperation. More healthcare staff, including care coordinators, should also help support further development of coordinated care networks.
Consolidating hospitals and improving their performance
The Polish hospital sector plays a significant role in the health system but is relatively large and inefficient. Two-thirds of hospitals are publicly owned, and they account for almost 90% of all available beds. There were around 900 private hospitals in 2022, which are usually small and focus on a single specialty. The number of beds in both the public and private sector relative to the population has been slowly decreasing, but it remains relatively high at 6.1 which is a third above the OECD average (Figure 2.7). Public sector hospitals accounted for 4.91 beds per population of 1 000. The occupancy rate was 71% in 2022, around 10 percentage points below countries with more utilised hospitals, such as Switzerland or the United Kingdom, suggesting a significant degree of overcapacity. Productivity growth has been small as hospital discharge rates rose only slightly over the past decade (OECD, 2023b).
Number of hospital beds in the public and private sectors per 1 000 population
Note: 1. Latest data from 2017.
Source: OECD Health Statistics.
The organisation of hospital care is relatively complex and suffers from a lack of coordination. The ownership and management of public hospitals is fragmented across ministries, medical universities and three levels of regional government comprising voivodes (regions), powiats (counties), and gminas (municipalities). Hospitals are funded centrally by the National Health Fund, which contracts the services and disburses the funds through its 16 regional offices. However, incentives for owners to ensure that hospitals are financially sustainable are low and the central government has periodically helped reduce debt. Since 2019, the Constitutional Tribunal has ruled that regional governments cannot be held responsible for their hospitals’ debt (Dubas-Jakóbczyk et al, 2023). Furthermore, there is no single steering entity at the regional or central level that could rationalise hospital resources, which is often politically resisted at the local level and especially when the hospital is the major employer in the city or county. As many as half of all hospitals generated a gross loss and 40% were in arrears in 2018. Total hospital debt was around PLN 25 bn at the start of 2024, equivalent to 0.7% of GDP, although this was exacerbated by the pandemic.
Hospital ownership and funding should be more closely matched to put the system on a more sustainable footing, align spending to available resources and improve incentives to increase efficiency and rationalise the available capacity. The reforms put forward in 2021 proposed centralising the hospital system or parts of it at the national level. But, full centralisation was resisted by regional governments, which own 85% of hospitals. An alternative could be to transfer ownership to the 16 voivodes, which would own all the hospitals in their region and receive funds for managing them but would need to accept financial responsibility to ensure that budget constraints are enforced. A regional setup would benefit from efficiency gains from some centralisation of management, as well as much better alignment of incentives. At the same time, the loss of flexibility at the local level can be mitigated through coordination with the region’s counties and municipalities, which is currently absent. New legislation proposed in 2024 offers flexibility and regulatory incentives for hospitals to merge, but on an entirely voluntary basis. Hospitals will be able to apply to move towards shorter treatments and to reduce services, subject to approval from the president of the National Health Fund. Those hospitals with losses over 1% of revenues, however, will be required to restructure over a ten-year period after which any outstanding debts will become obligations of the owners. The overall reform will be implemented in stages and should be completed by 2034, which should provide enough time for consultation and to develop sufficient ownership among stakeholders.
The hospital system needs to be rationalised to increase efficiency, reduce costs and better meet regional health needs. Detailed maps of health needs, published by the Ministry of Health, have not yet been used fully for planning hospital resources (WB, 2021b). The development of the hospital network was based on existing infrastructure and was not tailored to identified geographic health needs (Dubas-Jakóbczyk et al, 2019). The National Health Fund’s funding model differentiates spending based on a region’s population and age structure to an extent, but richer regions tend to be allocated more resources than poorer ones (Sowada et al, 2019). It is unclear to what extent minimum required levels of healthcare services proposed in the latest hospital network legislation will constrain hospital budgets. More binding measures could reduce overcapacity and improve financial sustainability. For example, reducing the number of beds to bring the hospital network to a size similar to Slovakia, Belgium or France, could reduce costs by around 0.2% of GDP. Some degree of spare capacity should also be reserved for emergencies, as the pandemic has shown. Existing infrastructure could be repurposed for other types of healthcare where feasible, particularly where hospitals account for a large share of local employment. Some hospitals are already being converted to long-term care homes as part of the Polish Recovery and Resilience Plan (RRP) (see Section 2.6.2) but other facilities could also be developed as primary health care centres.
Making more use of outpatient care could lower costs and boost efficiency. Inpatient care, which is care provided by hospitals, accounted for a third of all health spending in 2021, above the OECD average (Figure 2.8). This type of care tends to be more costly than outpatient care partly as a result of additional accommodation costs. However, advances in technology have allowed the duration of some medical procedures to be shortened and moved to outpatient care settings, improving the experience for patients and reducing the cost. Over 90% of eye cataract surgeries are now carried out as ambulatory cases, as in most OECD countries. However, the share of radiotherapy treatments conducted in a day is below 65% in half of the regions (Figure 2.9). The share of tonsillectomies carried out on the same day was only 2.5% in 2021, far below the OECD average of 40% (OECD, 2023a). Greater use of outpatient care is financially incentivised within the hospital network, but does not include one-day procedures, which are contracted separately (Dubas-Jakóbczyk et al, 2019). Hospitals outside the network, mostly private, do not have such incentives. The use of financial incentives to further encourage the shift from inpatient to outpatient care should be broadened.
Health expenditure by type of service, 2022 or latest
Note: Countries are ranked by curative-rehabilitative care as a share of current expenditure on health.1. Refers to curative-rehabilitative care in inpatient and day care settings. 2. Refers to outpatient care, including specialist care, as well as home care and ancillary services.
Source: OECD Health Statistics.
Share of one-day radiotherapy treatments by region, 2023
Source: Centrum e-Zdrowia.
More coordination at the national and regional level could lead to better utilisation of existing resources and unlock additional efficiency savings. There are no formal joint procurement schemes for medicines and equipment, which could reduce costs (Sowada et al, 2019). Procurement of medicines and equipment can be coordinated between hospitals with the same owners, such as a voivodeship. Moreover, central government decisions on salaries for nurses and doctors are not reflected in a timely manner in the National Health Fund’s contracted healthcare services. Consequently, recent sharp increases in wages are exerting additional financial pressure on hospitals. Better coordination and synchronisation at the central level of government could reduce some of the financial pressure on hospitals.
Comprehensive measurement of quality will enable improvement in hospital healthcare. The 2017 hospital reform only considered financial indicators when assessing hospital performance. However, safe equipment accounts for less than 50% of all equipment owned while only 27% of hospitals use an electronic register of adverse events (IPPiEZ, 2023). The 2023 Health Care Quality and Patient Safety Act will raise the level of healthcare quality and patient safety, and a set of indicators is being developed. Some hospitals already collect data on quality but not in a consistent manner (WB, 2021b). To be effective, quality assessments at the system as well as hospital level should be related to management and staff objectives to incentivise increases in performance.
Improving management will be essential to drive better hospital performance. Low management quality has, in part, contributed to hospital indebtedness (WB, 2021). Several case studies of highly indebted hospitals indicated the existence of numerous problems related to ineffective management. When reforms were implemented in the past, they were often not complemented with appropriate management changes in individual hospitals. Many hospitals’ financial sustainability was little improved by previous debt relief programmes (Dubas-Jakóbczyk and Koziel 2020). Management quality should be raised by developing leadership and managerial capacity through mandatory training. Executive education programmes at universities, aimed at middle and senior hospital executives, were recently expanded and proposed legislation will require hospital managers to undergo additional training in restructuring and management methods. However, equally important will be to introduce accountability mechanisms whereby good performance is rewarded and bad performance sanctioned.
Reaping the benefits of digital healthcare
The pandemic accelerated the digitalisation of healthcare in Poland. Online services available in the Patient’s Portal have been significantly expanded to include e-prescriptions, teleconsultations, e-sick leave, e-referrals and electronic medical records. People can securely view and control access to their medical information. Teleconsultations were rarely used prior to the pandemic, but by 2021 62% of adults had a teleconsultation. Teleconsultations made up just under a fifth of all doctor consultations in 2022 and are now firmly established (Figure 2.10) (OECD, 2023b). In 2022, 96% of prescriptions were electronic and sick leave is paperless. These services are also available in a mobile app, both in Polish and Ukrainian, making healthcare services even more accessible. As a result, the maturity of Poland’s e-health systems has been ranked as the fifth highest in the EU in 2022 (EC, 2024b).
Nonetheless, the use of digital healthcare for primary uses should be further improved. Housed in the Ministry of Health, the e-Health centre has developed and maintains the central health platform that allows healthcare provider systems to connect, view, record and share medical information. Around 80% of medical entities and practices have enough equipment and IT solutions to enable electronic medical records to be created, processed and stored. However, the use of electronic medical records could be developed more. Around 40% of facilities do not have a repository for medical records. Less than half of practices are not indexing records in the central health system and less than 20% use the system to exchange information with other medical practice. Instead, electronic health records are exchanged through hard copies. While digitalisation is generally welcome by healthcare staff, more than half of entities and practices in the health sector face barriers to further digitalisation. Two thirds of hospitals and, overall, a third of all entities identified a lack of sufficient financial resources as a key barrier while around a tenth reported a lack of digital skills as an obstacle to further digitalisation (CeZ, 2023). Investment will be bolstered by the EU Recovery and Resilience Facility funds although they have been delayed and are time-limited. Poland should ensure sufficient financing for digital projects, particularly among hospitals.
Annual doctor teleconsultations per person
Note: The OECD19 average includes Australia, Belgium, Czechia, Denmark, Estonia, Finland, France, Germany, Hungary, Israel, Korea, Lithuania, Luxembourg, Norway, Poland, Portugal, Slovenia, Spain, and Sweden.
Source: OECD Health Statistics.
There is potential to develop more analytical capacity. Rules and regulations are guided by the EU and, similar to other Member States, Poland is participating in the development of the European Health Data Space. Technical standards that drive data integration and use are in place and Poland has key institutions to support the digitalisation of the healthcare system. But to make the most out of the data, further developing analytical skills will be key. Currently, data is used to develop maps of health needs and some health providers already use artificial intelligence (AI) in oncology. The e-health centre is also developing a data management tool to improve the collection and distribution of blood in the health sector. But, there are many more potential uses of health data. To support secondary applications of data, digital skills and advanced analytics in medical education should be expanded. Poland should also invest more in advanced analytics in the Ministry of Health, the National Health Fund and regional authorities.
A shortage of healthcare workers has contributed to subpar quality of healthcare, although in recent years Poland has made significant progress in boosting the numbers of nurses and doctors. Adequate healthcare staff levels are essential to a resilient healthcare system since workloads can surge during a crisis as the pandemic has shown (OECD, 2023f). Poland has experienced a persistent shortage of health workers due to an insufficient number of medical and nursing graduates, an ageing workforce, and migration. This has contributed to long waiting times and lower access to healthcare (NIK, 2022). At the end of 2023, there were 7 674 vacancies, accounting for around 1% of all jobs in the healthcare and social work sector. Shortages of healthcare staff tend to be more pronounced in small counties, around large cities and in rural areas (Sowada et al, 2022).
The number of health workers relative to the population is low in Poland compared to other OECD countries. Although it has been slowly rising since 2008, employment in the healthcare and social sector made up just 6.5% of the total in 2021, a third lower than the OECD average and lower than in most European OECD countries. In 2022, there were 3.5 practising doctors per 1 000 people, which was around the OECD average, but there were just 5.7 nurses per 1 000 people (Figure 2.11). To reach average OECD levels, Poland is boosting the number of doctors, but it will have to increase the number of nurses by around 50% or 115 000 nurses from 2022 levels to reach this norm. The numbers of dentists and pharmacists are also below the OECD average. Poland has the fewest care workers relative to its population in the OECD (OECD, 2023a). At the same time, Polish health and social care staff worked some of the longest hours among European countries, averaging 39.1 hours per week in 2023, which is around four and half hours more than the EU average. While this can help increase the volume of care, it can create risks to patients and to medical staff, as well as make the profession less attractive.
Notes: The OECD average is unweighted.
Source: OECD Health Statistics.
In the context of a declining workforce and a tight labour market, increasing the healthcare workforce will be a significant challenge. More workers will be needed as the demand for healthcare grows, but the ageing workforce is likely to worsen the shortage further. Projections suggest that between 2020 and 2030 the demand for additional healthcare staff will rise by 31%, while it will rise by 51% in social care, more than three times as fast than the average projected growth in the EU (Schneider et al, 2022). Addressing this will require a sustained multi-pronged policy effort. Improving working conditions will play a key role as remuneration has become competitive. Better retention policies will help keep some nurses and doctors working for longer. However, more doctors and nurses, in particular, will need to be trained in priority areas. Poland could also make more use of immigration to boost its healthcare workforce. To ensure an adequate healthcare workforce for the future, data collection will need to improve, and long-term comprehensive strategic planning is needed.
Improving working conditions, ensuring competitive pay, and boosting retention
Poor working conditions, characterised by long hours and a high workload, have been a longstanding issue (Sowada et al, 2019; Domagala et al, 2022). Alongside pay, working conditions have been one of the main issues in healthcare staff protests in 2017 and 2021. In the past, they were a key reason driving emigration of nurses and doctors from Poland (Domagala et al, 2022). There is evidence that long hours and high workloads have also worsened the quality of medical care and (NIK, 2023). This has potential implications for patient safety. For example, a recent study in Australia suggests that an additional patient per nurse increases the likelihood of inpatient death by 7% within 30 days (McHugh et al, 2021). Working conditions in the health system need to improve to make the medical profession more attractive.
Setting personnel standards for the whole healthcare sector can lead to better working conditions. The Labour Code regulates Occupational Health and Safety, but this pertains to the physical safety of workers. Regulations that prescribe quality standards and working hours in healthcare are largely missing and those that exist are not enforced. For example, there is a general limit of 37 hours and 55 minutes per week for employees, but many doctors opt out. In some cases, doctors worked continuously for several days (NIK, 2023). For those working as contractors, there are no specified working hours and working conditions (Euraxess, 2024). Limits of working hours for nurses and midwives are set out in law but not enforced. More explicit guidance on working practices, such as setting limits on the number of patient consultations in a given time period and overtime hours, should be provided for all healthcare staff. Improving working conditions will necessitate additional resources as fewer hours will require more staff to maintain existing levels of healthcare and will need to be phased in gradually as more nurses and doctors are trained.
Nurses’ pay has become competitive following recent increases. In the past, relatively low salaries contributed to a low number of nurses, especially as many emigrated to other EU countries. Comprehensive regulation of minimum basic salaries in the health sector was introduced in 2017 and automatic annual indexation ensures they are raised at least at the rate of national average wage growth. Between 2019 and 2022, wage growth in healthcare was among the highest in the OECD (OECD, 2023f). In 2022, the ratio of Polish nurses’ average wages was 1.6 times higher than the national average wage, among the highest in the OECD average (Figure 2.12 A). When adjusted for differences in purchasing power, salaries relative to traditional destination countries such as the United Kingdom, have improved although they still below countries such as Germany and Belgium (Figure 2.12, B). In 2023 and 2024, wage growth has been around 12-13% each year and broadly in line with growth in the rest of the economy (OECD, 2023b). This has ensured that nurses’ pay relative to the average national wage remained competitive and automatic wage indexation should ensure these gains are maintained.
Doctors’ pay has risen strongly since 2012 and is now significantly higher than in the past, which has helped make the medical profession more attractive and has reduced emigration. However, the increases in specialists’ remuneration have not kept pace with increases for generalists and specialists’ remuneration remains lower in comparative terms. Doctors spend most of their time working in the public sector, but many also work in the private sector. In the public sector, general practitioners earned a little over twice the national wage in 2022, broadly similar to the OECD average (Figure 2.13, A). Appropriate pay for family doctors is helpful in encouraging people to choose this career path. However, unusually, specialists’ remuneration was far below those of generalists and among the lowest in the OECD in 2021 relative to the overall wage level (Figure 2.13, B). Relatively low remuneration can drive doctors to work in the private sector where they can earn more. Thus, there is scope to further boost the relative pay for specialised doctors, while maintaining pay for family doctors in order to continue supporting the shift towards primary healthcare.
2022 or nearest year
Note: In Panel A, remuneration refers to average gross annual income for nurses working full time, including social security contributions and income taxes payable by the employee. The data for some countries do not include overtime payments. Nurses’ income is compared to the national average wage of full-time employees in each country. 1. Data refer to registered (“professional”) nurses only in the US, Canada, Ireland and Chile (resulting in an over-estimation). 2. The data for New Zealand and Switzerland include “associate professional” nurses, who have lower qualifications and revenues. In Panel B, 1. The data also include “associate professional” nurses who have lower qualifications and income.
Source: OECD Health Statistics.
Remuneration relative to the average national wage, 2022 or latest available
Note: Remuneration refers to average gross annual income, including social security contributions and income taxes payable by the employee. It usually excludes practice expenses for self-employed doctors. Doctors’ income is compared to national average wages of full-time employees in each country. 1. Includes physicians in training (leading to an underestimation). 2. Includes practice expenses (leading to an overestimation).
Source: OECD Health Statistics.
Many nurses and doctors are close to or over retirement age (Figure 2.14). Since October 2017, the retirement age has been reduced to 60 years for women and 65 years for men regardless of the date of birth, which can exacerbate worker shortages. Around 20% of working nurses and 24% of doctors of retirement age. Poland has allowed older workers to benefit from pensions while working, which has increased financial incentives to postpone retirement but should also focus on areas where there are current or imminent shortages. For example, in the German state of Thuringia GPs aged 65 and above are eligible for additional pay in underserved rural areas (OECD, 2016). Non-financial incentives can be equally as important. Studies suggest that reducing working hours and workload intensity can encourage doctors to practice longer (Silver et al, 2016; Cleland et al, 2022). More flexible hours and shifts can encourage nurses to work longer, too (WHO, 2022; Rodwell, 2023). But, opening hours for practices run by family doctors are long and the regulations make it difficult for smaller practices to flexibly adjust them. These rules should be relaxed to facilitate the retention of older doctors and nurses, particularly in areas that are at risk of losing healthcare access due to retirement of healthcare staff.
Note: Data for nurses is for 2023. Data for doctors is for 2022 or the latest available year.
Source: Supreme Chamber of Nurses and Midwives; OECD Health Statistics.
Training more nurses and doctors
The rate of training of new medical personnel has been too low to keep up with needs, address shortages, manage the ageing workforce and support needed improvements in care. The training rate of nurses in Poland has been much lower than in most OECD countries (Figure 2.15, A). However, the number of nursing graduates has almost tripled from its low in 2016 to around 16 892 nurses in 2023 as the number of schools educating nurses and midwives expanded significantly to 121 schools. While the increase in training is sufficient to broadly maintain the existing nursing workforce, it is still far below the training rates needed to reach average OECD levels. Training healthcare assistants to take over administrative tasks from nurses, where appropriate, could also help boost effective nursing resources. Nonetheless, the number of nursing graduates needs to be raised substantially further. The additional number of nurses to close the gap with the OECD average could cost roughly 0.4% of GDP per year. More nurses will eventually allow for increased task-shifting and could free up doctors where needed.
More doctors are needed to meet demand. Between 2005-22, the authorities increased the number places in medical studies by around 160%. This has boosted training rates, increasing them 40-50% between 2011 and 2022, and resulting in a 20% increase in medical graduates over 2019-22. There were 5 500 medical graduates in 2022, representing a training rate slightly above the OECD average and this should continue rising as higher numbers of students graduate (Figure 2.15, B). New dentists were trained at rates above most OECD countries. The Ministry of Health, in coordination with the Ministry of Higher Education, has continued raising admissions and increasing the number of universities offering medical studies. For the 2024/25 academic year, the number of available places was 10% higher than in 2021 and available at two more universities, bringing the total to 33. In addition, five universities have applied but did not receive accreditation to provide medical education. There are shortages of lecturers, which can affect the quality of teaching, especially in universities that have not trained medical students before and in newly created courses (NIK, 2023). With the Ministry of Health aiming to further increase the number of medical admissions to 10 000, it will be important to accompany the additional expansion of medical education with adequate resources. While the target training rates will help address shortages in the medium term, there is a risk there could be an excess number of doctors in coming decades. The Ministry of Health projections suggest the supply of doctors could exceed demand by 2034. Thus, it will be important to calibrate training rates as part of workforce planning in order to avoid inefficiencies in healthcare spending.
Training rates per 100 000 inhabitants, 2022
Note: A large number of medical graduates are int’l students in some countries (e.g. Ireland, the Slovak Republic, Czechia and Hungary). Data excludes int’l students, resulting in an under-estimation (about 15% of graduates in Israel and 5% in New Zealand were int’l students in 2021).
Source: OECD Health Statistics.
The additional supply of doctors should be balanced across different specialisations. Since 2012, the Ministry of Health has designated specific specialties as priorities and increased the number of available residencies in those specialities (Michalik et al, 2024). In 2015, this was complemented by additional public funding for residency places (Sowada et al, 2019). The salaries for priority specialisations are higher than for other residencies. Currently, 23 specialities are prioritised out of a total of 77. Despite these incentives, some specialised training programmes such as those in internal medicine, paediatrics, and general surgery, do not attract a sufficient number of doctors (NIK, 2022). Interest in specialisations should be better aligned with needs.
Recent research suggests that financial compensation is a key driver of a choice of specialisation among medical graduates, especially as many would like the option to work both in the public and private sectors (Michalik et al, 2024). Yet, salaries for resident doctors in priority specialisations have decreased substantially relative to others although they are still higher than in non-priority specialisations (NIK, 2023). This differential should be raised. More generally, salaries across specialisations in the healthcare system could be more differentiated to entice medical graduates to specialise in fields where the highest shortages exist. However, non-financial factors such as working conditions and flexible hours are also highly important and specialisations that do not seem to offer a good work-life balance tend to attract fewer medical graduates (Michalik et al, 2024). Focusing on improving working conditions and, in particular, in specialisations with the highest shortages, could boost the number of doctors in those respective fields.
Staff also need to be broadly based across the country to ensure good access to healthcare. The geographical distribution of healthcare staff is uneven among Poland’s regions (Sowada et al, 2019). For example, Warsaw has three times as many physicians than the Wielkopolskie region relative to population (Figure 2.16). In general, urban areas tend to have more doctors than rural areas in many OECD countries. To mitigate this, the Ministry of Health has worked with regional governments (voivodeships) since 2008 to broaden medical education to non-medical universities in regions with high shortages and it is now possible to study medicine in all regions. For nurses, there are 121 public and private schools of which 36 schools also offer education for midwives (Sowada et al, 2019). However, they are less prevalent in the western part of the country. As part of its strategy on nursing and midwifery, the Ministry of Health is aiming to increase training places in those regions where the shortages are the highest (MZ, 2017). However, it is not clear that regional gaps have narrowed over time. Efforts to attract more doctors and nurses to rural areas could be complemented by admitting more students from rural areas by offering scholarships, for example, as this can also increase regional mobility (MacQueen et al, 2017).
Physician density, by level 2 regions, 2022 (or nearest year)
Note: Latest data for Denmark and Sweden refers to 2021 and 2020 for Finland.
Source: OECD Regional Database.
A package of policies combining financial incentives, administrative and professional support could further raise the attractiveness of working in rural areas. Survey evidence suggests that higher financial incentives are key to attracting more doctors to rural areas alongside administrative support for running a practice and support for professional development (Figure 2.17). Currently, there are no national financial incentives to take up work in rural areas, although some local governments offer additional stipends, housing allowances and travel assistance. The Ministry is working with local governments to help provide housing for nurses relocating to more remote areas (MZ, 2017). The Ministry should systematically introduce more financial support through fixed additional payments or higher capitation fees for doctors working in underserved rural areas. More flexible working hours would also help boost the work-life balance and may attract younger doctors. Developing primary health centres that allow multiple doctors to work in the same place could, in some cases, more efficiently provide additional support and flexibility. For example, France has financially supported doctors to set up their practices in underserved areas and given monthly stipends to medical students and interns who, after completing their training, agree to practise for a minimum duration in those areas.
Factors that would encourage doctors to work in rural areas, 2022
Note: The question asked in the survey was: “Which actions do you think would encourage young doctors to work in remote, rural areas?”. Financial support refers to financial incentives to work in rural areas. Administrative support includes finding appropriate premises, providing staff, co-financing employee training, and co-financing equipment purchases. Support for the family refers to help with finding work for spouses and/or help with placing children in a nursery or kindergarten. Advisory support refers to tax and legal advice.
Source: Federation of Health Care Employers’ Associations(2022).
Making more use of foreign workers
Greater use of foreign workers could help alleviate labour shortages in healthcare, particularly given the lags in expanding the number of Polish healthcare professionals. Foreign-trained nurses only accounted for 0.4% of nurses in Poland in 2022, one of the lowest shares among OECD countries (Figure 2.18, A). They have historically mostly come from Ukraine (Janik, 2020). More foreign nurses should be attracted to help address shortages in the short term, including in long-term care. Raising the number of foreign-trained doctors can also fill vacancies. Only 3.8% of doctors were foreign-trained in Poland, well below the OECD average (Figure 2.18, B). They tend to be mostly from Ukraine, Germany, Belarus, Czechia, Lithuania, Russia, Syria and Sweden (Kowalska-Bobko et al, 2021).
Poland has made it easier for foreign non-EU healthcare professionals to work in the Polish system. While there are no restrictions on EU nationals working in healthcare in Poland, professionals from non-EU countries had to meet a number of requirements before they can practice in Poland. This included the recognition of a foreign diploma, evidence of an internship, a medical examination, and fluency in the Polish language. Since 2020, the immigration process has been considerably simplified. Now, medical licenses can be directly issued by the Ministry of Health, and foreign healthcare professionals have five years to meet the requirements. Adequate knowledge of Polish language is still required, but no formal test is necessary. A dedicated hotline has been established in 2022 to assist with the application process. This has paved the way for 5 408 Ukrainian healthcare professionals to obtain a temporary medical license by September 2024. Simplified procedures, conditional on minimum quality criteria and a working level knowledge of Polish, supports higher immigration, which will help address staff shortages. Proving training support for learning the Polish language and improving medical skills is important in ensuring the successful integration of foreign healthcare workers.
2022 or latest year available
Source: OECD Health Statistics.
Polish migration policy should capitalise on a simplified immigration system for healthcare professionals. Having been suspended since 2016, a new migration strategy for 2025-30 is being developed. It should consider targeted bilateral migration programmes as these could boost the supply of foreign medical professionals. Several OECD countries have set up mutually beneficial migration programmes for healthcare professionals in order to facilitate migration between countries. The United Kingdom has signed memoranda of understanding with India, Kenya, Malaysia, Nepal, the Philippines and Sri Lanka to develop migration pathways that benefit the UK and the sending countries. Germany established a similar bilateral agreement with Vietnam in 2012 to train and recruit geriatric nurses, while also providing German language training (OECD, 2016). Italy has concluded bilateral agreements with Argentina and Paraguay and is currently exploring a new agreement with India to allow for the migration of nurses. Poland could benefit from a similar bilateral programme to facilitate migration from non-EU countries. It should launch campaigns in selected countries to attract more nurses, including care workers, and doctors while respecting the WHO’s global code of practice on the international recruitment of health personnel.
Healthcare workforce planning needs to improve
Healthcare workforce planning could be improved through better data collection. At present, data collection is dispersed across several institutions and collected data may not always be coherent. For example, there have been large discrepancies in the nationally reported number of human resources in health and the numbers reported to international databases (Sowada et al, 2022). There are also concerns that the collected data is not complete. Central registers for nurses and doctors have not been updated on a timely basis, while no registers exist for some medical professions such as paramedics (NIK, 2022). In addition, some information such as hours worked is not collected, making it difficult to conduct evidence-based policies. There have been some improvements in using a range of databases to estimate the number of doctors, dentists, nurses and midwives (Statistics Poland, 2023). However, further progress in data collection on the healthcare workforce is necessary. Digitalisation offers an opportunity to gather more detailed and higher quality data.
Healthcare workforce planning needs to be strategic and long-term, underpinned by analytical capacity. The Department for Analysis and Strategy within the Ministry of Health is developing detailed models for the supply of medical staff and demand for healthcare services in order to make healthcare workforce projections (NIK, 2022). Poland is also participating in the EU HEROES Joint Action platform where countries exchange best practices on workforce planning and forecasting. However, long-term projections are not systematically used in workforce planning. Decision making is still ad hoc as the Ministry of Health and the Minister of Science and Higher Education set admission limits for studies annually based on proposals by universities while training decisions are made each year in collaboration with regional governments (NIK, 2022). Moreover, in recent years, the Ministry announced admission limits only after universities started accepting applications. Although the authorities have a specific strategy on nursing and midwifery, there is no long-term comprehensive healthcare workforce strategy.
Detecting diseases earlier and treating them faster
Mortality rates from treatable conditions remain elevated. Close to 10% of all deaths in 2019 could have been avoided through timelier and more effective healthcare interventions (Figure 2.19). Treatable mortality rates have fallen in line with the OECD average between 2010 and 2019, but progress has been slower than in other similar countries and it slowed due to a rise in deaths related to COVID-19. Still, treatable mortality remains around 40% higher than the OECD average. The most common causes of death that could have been avoided through treatment are ischaemic heart disease, stroke, and cancer. Overall, cancer mortality was the fifth highest in the OECD. Men are much more likely to die from cancer than women partly because cancers that affect women in Poland are more treatable (OECD, 2023d). To reduce the number of premature deaths, it is essential to detect disease early and proceed to treatment quickly and effectively.
The risk factors that lead to coronary heart disease, hypertension and stroke need to be better monitored. These risk factors are unhealthy diets and insufficient physical activity, obesity, high cholesterol, irregular heartbeats and diabetes. Poland has introduced a voluntary testing programme in July 2021, “Prevention 40 Plus”, for people aged 40 years to diagnose risks of chronic diseases. The programme has been repeatedly extended and currently lasts until 2024. Early results have been encouraging as around 10% of the eligible population has taken part and some patients have had health risks detected at an earlier stage than otherwise would have been the case (Gumulka, 2024). There are long-term benefits to better health monitoring and the programme should be made permanent, similar to health checkups offered by national insurance systems in Austria, France and Germany. However, its implementation and scope need to be evaluated so that future iterations can be improved. Moreover, as part of a greater focus on prevention in primary healthcare, family doctors should be financially incentivised to encourage at-risk patients to participate.
Deaths per 100 000 inhabitants (standardised rates)
Source: OECD Health at a Glance 2023.
Detection of cancer needs to improve. The incidence of cancer in Poland is below the EU average, but mortality rates tend to be higher than the average. The most common forms of cancer are breast, prostate, lung, colorectal, uterus and bladder cancer. Poland has been running free nationwide screening programmes for breast, cervical and colorectal cancer since the early 2000s. For cervical cancer, screening participation rates are roughly in line with the EU average. However, participation rates are low for breast cancer screening. Only 54% of women aged 50-69 in 2019 report having had a mammogram in the preceding two-year period, below the EU average. While just a third of the target population attends colorectal cancer screening in the EU, this is even lower at 8% in Poland. The participation rates tend to be lower for people with lower education (Figure 2.20). Other cancers are not systematically screened for. As a result, when cancer is detected, it is often detected at a later stage. Late diagnosis is associated with higher cancer mortality.
Survey-based screening rates, 2019
Note: The data refer to self-reported screening rates based on the European Health Interview Survey.
Source: Eurostat.
Nationwide cancer screening programmes should be strengthened. Cancer screening is free and can be accessed without referrals. Coverage for breast cancer testing was extended to ages 45-74 as per EU recommendations, while for colorectal cancer testing Poland should raise the upper age limit from 65 to 74 as many other European countries have already done (OECD, 2024a). Participation rates should be boosted through more intensive outreach. Since 2022, invites are also sent out via the online patient portal. This should be complemented with SMS and phone calls as multiple invites are more effective in raising participation (Gruner et al, 2021). Family doctors and nurses should play a bigger role in referring at-risk patients to cancer screening. Additional cancer awareness training would support family doctors with referrals and could improve participation in screening. The National Cancer Plan 2020-2030 plans to fund and conduct information campaigns to encourage higher participation in cancer screening.
Regional disparities in cancer screening should be narrowed. Cancer incidence rates vary as much as 46% between regions in Poland (Figure 2.21). To further expand access, Poland runs mobile mammography buses to smaller towns and remote regions. In addition, a non-invasive faecal blood test for colorectal cancer has been recently introduced, which can also be taken remotely. Easier access to testing should help boost participation, but additional efforts to raise awareness, particularly among the less educated and lower income groups, are needed. France and Spain use pharmacies’ wide accessibility and familiarity with patients to increase screening in more remote areas by educating on colorectal cancer and distributing tests (OECD, 2024a). Poland could make more use of its national cancer registry to target people who haven’t responded to previous invites. Informational campaigns should use plain language and visual materials in partnership with local communities to reach less educated groups. For example, France and Germany employ simple language and easy-to-read-and-understand screening materials to ensure accessibility for people with low literacy levels while Slovenia and Sweden use peer-to-peer helpers who educate those within their community networks about screening (OECD, 2024a).
Percentage difference between regions with the highest and lowest cancer incidence rates, latest year
Notes: Data are not directly comparable between EU+2 countries due to different methodologies and years of observation. For Denmark, Norway, Ireland, Sweden, Iceland, Croatia, Germany, Czechia and Bulgaria, an average of the regional differences for men and women was used. Other countries provided a measure for the total population. For Czechia, the regional incidence data only consider breast cancer for women and prostate cancer for men.
* Provisional data.
Source: OECD Policy Survey on Cancer Care Performance (2023).
Poland should consider broadening screening to other cancers. Currently, there are no lung or prostate cancer screening programmes, and the National Cancer Plan 2020-2030 envisions their introduction. Detecting prostate cancer and lung cancer can have health costs. The rate of false positives in prostate-specific antigen tests can lead to misdiagnosis while lung screening can involve harmful radiation. Poland is conducting a pilot study as a part of PRAISE-U, an EU funded project involving 12 countries, which is exploring the development of cost-effective approaches for early detection of prostate cancer (OECD, 2024a). For lung cancer screening, Poland ran a pilot programme between 2021 and 2023 targeting older heavy smokers. Evidence from an earlier regional lung cancer testing programme in Pomerania suggests they could be cost-effective (Kanarkiewicz et al, 2015). To the extent that local evidence points to public health benefits outweighing the costs, including possible false detection and overtreatment, other cancers should be tested for as well.
Treatment needs to be timelier. Five-year cancer survival rates are among the lowest in Europe (OECD, 2024a). Poland has implemented several policies to improve access to cancer care. In 2015, it introduced fast-track diagnostics and treatment pathways to speed up treatment. This led to lower waiting times for treatment but waiting times for related services, such as follow-up cancer care, increased (OECD, 2023d). In 2019-2021, the National Oncology Network has been piloted, to improve the organisation of the cancer care system with standardised patient pathways, expertise in highly specialised procedures, and quality monitoring (WHO, 2022). The network has been rolled out nationwide in 2024. There is no upper limit on the costs of cancer treatment. These reforms should improve treatment, but without more detailed evaluation they might not be well adapted to the Polish healthcare system. For example, one concern is that there is over reliance on an already stretched primary healthcare system and not enough focus on preventive measures (Sagan et al, 2022c).
Cancer care needs to be better resourced. The shortage of healthcare staff also affects cancer care. Poland has had the lowest relative number of pathologists in the EU, which can limit the number of diagnoses. Despite increasing by 13% over 2019-2023, more doctors specialising in clinical oncology are needed (OECD, 2023d). The lack of equipment limits capacities in treatment. For example, the number of radiotherapy centres is 70% below the EU average and among the lowest. Moreover, oncological care is unequally spread across regions and between urban and rural areas. Palliative care is well developed largely because there are many out-patient hospices, but end-of-life care is often provided informally by families or non-governmental organisations. In purchasing power parity terms, cancer spending in Poland is similar to other Central and Eastern European countries, but lower than the EU average (OECD, 2023d). This has been recognised in the National Cancer Plan 2020-2030, which aims to raise survival rates and improve early detection.
Mental health problems are a concern but remain undertreated. Survey data reports that 14% of people in Poland had mental health problems in 2019, which was below the EU average. Only 4% reported having depression compared to an EU average of 7%. People from lower incomes were more likely to suffer from depression, with women in low-income households the most affected (OECD, 2023b). However, the true prevalence of mental health issues could be higher. Low awareness, high stigma of mental illness and limited healthcare access may lead to a lack of diagnosis meaning that many mental health issues could be underreported. Administrative data on suicide rates suggests that, despite significant progress made since 2000, there were still around 12 suicides per 100 000 people in 2021. This was almost twice as high for men, whose suicide rate is above the EU average (Figure 2.22). There are indications that the pandemic worsened mental health (Wojtyniak and Goryński, 2022). Around a quarter of unmet health needs were related to mental healthcare in 2021-22 (OECD, 2023b). The economic cost of mental disorders is substantial and previous estimates put the cost at 2.8% of GDP for 2015 (OECD/EU, 2018).
Deaths per 100 000 population (age-standardised rates)
Source: Eurostat.
The authorities have made progress towards addressing mental health issues and this should continue. In the past, funding for mental healthcare was very low, accounting for 3% of the National Health Fund’s expenditure, and was allocated to psychiatric hospitals (Sagan et al, 2022b; Sowada et al, 2022). The second National Mental Health Protection Programme piloted community mental health centres from 2017 to 2022. The results were positive and the number of centres rose from 40 in 2018 to 107 in 2024, accessible to 13.5 million citizens (OECD, 2023b). However, due to a lack of infrastructure, most of the community mental health centres were located in psychiatric wards. This may have contributed to social stigma and limited their use. The shift to community mental health centres is planned to continue, with a target of 250-300 new centres by 2027, but new establishments should be separate from hospitals to reduce stigma. Furthermore, they should offer a wider range of mental healthcare services to provide comprehensive and coordinated care (OECD, 2024b). The development of new facilities will also necessitate training more specialists as discussed in Section 4.2 although Poland’s innovative recovery assistants, recruited from previous patients, may partly alleviate staff shortages. More broadly, Poland has implemented the WHO’s mhGAP programme that will train Polish family doctors to better recognise symptoms of common mental health conditions and give them tools to address these issues or refer patients to specialists at community mental health centres. Funding for mental healthcare has also been recently increased to PLN 4.2 billion, partly supported by EU funds.
A new programme for 2023-30 will provide more community care and focus on the mental health of children and young adults. It also aims to reduce social stigma through information and educational campaigns. Attitudes to mental health in Poland tend to be relatively positive compared to other countries, but a quarter of adults still view it as different to other health issues (The Policy Institute, 2019). These campaigns should help raise mental health awareness and they tend to work best if conducted over a longer period of time as UK experience has shown (Box 2.5). Overall, these efforts should improve mental health, as well as resilience, as the pandemic has shown how mental health, particularly among young people, can deteriorate quickly in a crisis (OECD, 2023f).
In the United Kingdom, the Department of Health organised a ‘Time to Change’ national programme, funded by public funds and donations, and delivered by charities, to help improve mental health and increase awareness in society as a whole.
The Time to Change programme ran in three phases between 2007 and 2021. It was a comprehensive programme that ran national advertising campaigns, partly through social media, but also targeted the low to middle socio-economic groups and engaged directly in those communities. While the first two phases focused on groups aged 25-45 and covered a broad set of issues, the final phase of the programme focused on men’s mental health. Celebrities and politicians widely participated to advance mental health awareness.
The programme was considered successful. It significantly advanced the population’s awareness and knowledge of mental health issues and reduced stigma. However, improvements in the knowledge of mental health and the acceptance of people with mental health issues took some time to occur, pointing to a need for consistent and long-term campaigns. While social stigma decreased in the population, the gap between men and women had not narrowed in the first two phases of the programme, suggesting tailored campaigns targeted at men might be necessary to drive further improvements.
Source: Mehta et al (2009); Henderson et al (2016, 2020).
Boosting health through more prevention
Preventable death rates continue to be relatively high in Poland. Over two fifths of all deaths in 2019 were estimated to be due to preventable causes, that is, they could have been mainly avoided through public health and primary prevention programmes. Poland had reduced preventable mortality rates between 2000 and 2014 by 30%, but progress has stagnated since 2014. Moreover, preventable deaths increased by 25% in 2020 due to COVID-19. Preventable mortality remains well above the EU average, particularly among men (Figure 2.23).
Many preventable deaths are due to lifestyle choices and are related to a handful of risky behaviours (Figure 2.24). Nearly a fifth of all deaths could be attributed to tobacco (including second-hand smoke), above the EU average. Dietary risks contributed to another fifth of all deaths, above the EU average, while physical inactivity accounted for 2% of deaths (OECD, 2023b). Alcohol consumption is among the highest in the OECD (OECD, 2023a). It was responsible for 6% of all deaths in 2019 and alcohol-related mortality increased during the pandemic (Silczuk et al, 2023). Air pollution is pronounced and accounted for an estimated 8% of all deaths in 2019, twice the EU average (OECD, 2023b; 2023d).
Standardised death rates for preventable diseases/conditions, persons aged less than 75 years, by gender, 2021 (per 100 000 inhabitants)
Source: Eurostat.
2022, or latest available
Note: The green circles represent the minimum and the orange circles the maximum observation in the OECD for each variable. Data for alcohol, smoking and obesity is for 2022 or the latest year available while the latest data for air pollution is 2021.
Source: OECD Health Statistics 2023, OECD Environment Statistics 2020, WHO Global Health Observatory.
Prevention policies typically have a high return on investment and spending on programmes that address risky behaviour and prevent people from developing diseases is highly beneficial. The 2015 Act on Public Health placed more emphasis in the National Health Programme on the promotion of healthier lifestyles and the reduction of important risk factors (OECD, 2023b). However, spending on preventive healthcare has remained broadly flat since 2015 and stood at 0.1% of GDP in 2022, among the lowest in the OECD. Given some of the highest avoidable mortality rates in the OECD, boosting preventive spending in a targeted and cost-effective manner could improve health outcomes and raise overall healthcare efficiency. Better health can also make the population more resilient in a crisis as experience during the pandemic has shown, when people in poor health were particularly at risk (OECD, 2023f).
Alcohol consumption is high. Polish people tend to drink beer and spirits, consuming 11 litres of pure alcohol on average per person in 2021, among the highest in the OECD (Figure 2.25). Official consumption has risen by 10% since 2010 while it has fallen in most OECD countries. Around a third of adults engage in heavy drinking each month, defined as consuming six or more drinks on a single occasion, with men drinking three times more alcohol than women (OECD, 2021d). Harmful alcohol use leads to many non-communicable diseases and premature deaths. It lowers economic growth through lower employment and productivity. Based on current consumption patterns, OECD simulations for Poland suggest that diseases and injuries caused by drinking above 1-1½ drinks per day lead to treatment costs equal to 3.1% of health expenditure and a level of GDP level that is 3.1% lower on average between now and 2050 (OECD, 2021d).
Consumption of alcohol among the population aged 15 years old and over (litres per capita)
Note: Reflects official and measured consumption and excludes unregistered alcohol consumption such as domestically produced spirits.
Source: OECD Health Statistics.
Alcohol prices need to increase in a consistent and steady manner. Financial measures, such as excise taxes and minimum unit prices on alcohol, are effective in discouraging consumption although they are regressive as the tax burden falls heavily on lower value drinks more available to low-income households. Ad valorem taxes tend to be more progressive but are not related to alcohol content and are, therefore, less effective in deterring consumption. In Poland, excise duties on alcohol were raised annually between 1993 and 2001 and contributed to a fall in consumption to 7.8 litres per capita by 2001. However, alcohol excise duties were reduced by 30% in 2003 and were subsequently raised infrequently at rates below inflation and wage growth. Nominal levels of excise duties seen in 2002 were only reached again by 2020 (Figure 2.26). As a result, alcohol affordability has risen 2.5 times and consumption surged by 40% over two decades (Neneman, 2021). The authorities have raised excise duties by 10% in 2022 and 5% in 2023, and they plan to continue raising them by 5% until 2027. Further increases should continue to be steady and specific alcohol excise taxes should be at least indexed to inflation and real wage growth to ensure reductions in affordability are persistent. However, international cooperation is key to avoid cross-border leakage. EU directives on minimum excise rates on alcohol have remained unrevised for 30 years (Neneman, 2021).
Tighter restrictions on availability should complement higher alcohol prices. Over the last couple of decades, Poland has relaxed restrictions on purchase and advertising of alcohol (Rehm et al, 2023). Alcohol is widely available and can be bought in many retail outlets without any restrictions on the time of sale (OECD, 2021d). Introducing time limits on alcohol purchases can help. Furthermore, sales of alcohol should be restricted to fewer outlets. Latvia has banned alcohol sales at service stations. Evidence suggests lower outlet density can lead to lower alcohol consumption (OECD, 2021d). Smaller bottles sizes have made alcohol more accessible and should be banned. In addition, raising the minimum legal age for purchasing alcohol from 18 to 20 could help reduce harmful use as experience from Lithuania has shown (Rehm et al, 2023).
Policy changes and levels of excise rates on spirits
Source: Ministry of Finance.
Reduced availability should be supplemented with additional restrictions on alcohol advertising. Bans on advertising can help reduce exposure and reduce consumption, particularly for young people. However, there is only a partial ban in Poland. This should be extended to a full ban on alcohol advertising like in Estonia and Lithuania, which also suffer from high alcohol consumption (OECD, 2021d). Sponsorship of sports can be harmful as it is associated with initiation of drinking for previous non-drinkers and higher levels of consumption among current drinkers (OECD, 2021d). Poland bans the advertising of spirits in sport and this should be extended to other forms of alcohol as well. For example, Spain, France, Norway and Türkiye have implemented bans on sport sponsorship across all beverages (OECD, 2021d).
Smoking has become less common, but still remains a public health risk. As in most OECD countries, smoking rates in Poland have fallen from 24% in 2011 to 17% in 2019, around the OECD average. Just under half of all smokers were heavy smokers, which was above the EU average. Men are more likely to smoke than women and smoking is less prevalent among those with higher education. However, cigarette consumption reversed its long-term decline and started rising again in 2015 (Zatoński et al, 2023). Furthermore, e-cigarettes are becoming increasingly popular among younger people (Pinkas et al, 2019). The share of adults aged 15 years and older who used e-cigarettes, every day or occasionally, was 6% in 2019, the highest in the EU. Economic costs associated with tobacco use are substantial, amounting to PLN 58.3 billion in 2022 or 2% of GDP (Drope et al, 2022).
Tobacco should be made less affordable to discourage consumption. Excise duties, one of the most effective policy tools to disincentivise tobacco use, have been frozen in nominal terms from 2015 to 2019 (Zatoński et al, 2023). This has made cigarettes more affordable and reversed previous progress. Cigarettes in Poland were among the least affordable in the OECD in 2014, but this fell to the OECD average in 2022 (Figure 2.27). Currently, the authorities are raising tobacco excise duties by 10% annually from 2023 to 2027. There are plans to further increase planned excise duties in 2025-27 to account for recent strong growth in wages. In addition, excise duty rates on e-cigarettes are planned to more than triple over 2025-2027 albeit from a low base. Future increases should continue to rise at least as much as inflation or real wages to ensure tobacco does not become more affordable again. To help long-term and heavy smokers quit, Poland should re-introduce free treatment for tobacco dependence that was withdrawn in 2016. The authorities should also run smoking cessation campaigns targeting male smokers.
Note: Affordability is measured as the percentage of GDP per capita required to purchase 2000 cigarettes of the most sold brand.
Source: WHO.
Further restrictions on sales of tobacco and nicotine products are needed. Since 2016 there has been little progress on tobacco control policies. The government opted to observe minimum standards set out the by EU Directives while other countries acted to further discourage tobacco consumption. At the same time, enforcement of existing laws was unsatisfactory due to weak age verification (Zatoński et al, 2023). Advertising of tobacco and vaping is common in night entertainment venues (Nowicka and Balwicki, 2023). Poland should consider completely banning advertising of tobacco and tobacco-related products, including e-cigarettes. To reduce their appeal, it should adopt plain packaging and ban flavours, particularly for e-cigarettes. Compliance with regulations will need to be strengthened, too. Age verification is not legally mandatory (Stoklosa et al, 2021). It should be made so with fines applied in cases of non-compliance.
Almost 60% of all adults in Poland were overweight in 2022, above the EU average. This was more pronounced among men (Figure 2.28). This is increasingly becoming an issue for adolescents, as overweight and obesity rates have increased over the past two decades, reaching 20% in 2022 among 15-year-olds (OECD, 2023b). The rise in obesity can be ascribed to increasingly unhealthy lifestyles, including poor diet and nutrition, and insufficient levels of physical activity and sedentary behaviour (OECD, 2019). Overweight adults and associated diseases such as diabetes, cardiovascular diseases and cancer lead to worse outcomes across a range of measures and higher health spending. Simulations suggest that Poland will be one of the most affected countries. Such conditions are estimated to shorten average life expectancy by 3.9 years between 2020 and 2050, reducing the level of GDP by 4.3% due to lower employment and productivity (OECD, 2019b).
Prevention policies that aim at improving nutrition tend to have a high return on investment and could reduce these potential costs (OECD, 2019b). Poland has set out objectives on adult and child obesity in successive National Health Programmes. It developed national food and dietary guidelines to help people make better nutritional choices. The National Institute of Public Health is the key national institute that undertake research on obesity and related issues, such as nutrition, and provide data to support the Ministry of Health. Together they implement prevention programmes at the national levels. Regional and local governments have engaged in this process to a limited extent due to restricted availability of finance and relevant skills (Brzeziński et al, 2019). In 2017, the National Centre for Nutrition Education was established to promote knowledge of healthy nutrition. As a part of this effort, the Online Diet Centre offers free consultations with dieticians and nutritionists to all adults and children. Poland participates in the EU Fruit and Vegetable Scheme and since 2015 foods high in sugar, fat and salt have been banned from school menus. Education materials on nutrition have been available to teachers from 2020 onwards (WCRF, 2024). However, nutrition still needs to improve. While the share of people eating fruit and vegetables has risen over time, fewer than one in ten adults consumed at least five portions of fruit and vegetables per day, recommended by the WHO as a key element of a healthy diet, and 38% consumed no fruit or vegetables on a daily basis in 2019 (OECD, 2022c).
Overweight (including obesity) rates among the adult population, by gender, 2022
Note: Adults defined as people aged 18 years old and over. The EU average is weighted. No data is available for Ireland.
Source: OECD Health Statistics.
Raising the relative price of unhealthy food and drinks can improve nutrition through lower consumption of unhealthy products and lead to improved nutritional composition of food and drinks. In 2021, Poland introduced fees on sugar-sweetened beverages as well as on drinks containing caffeine/taurine. The share of people consuming sweet drinks on a daily basis more than halved between 2018 and 2022 and in many cases beverages have been reformulated to reduce sugar content (Wojtyniak and Goryński, 2022). Poland should go further and introduce a broader health tax levied on unhealthy food. While taxes on unhealthy foods are less common in OECD countries, Mexico and Hungary have introduced them. In 2011, Hungary introduced an excise levy on the salt, sugar, fat, and caffeine content of pre-packaged foods for which there were healthy alternatives. Some studies have suggested that this had led to lower consumption of the targeted products, particularly by overweight and obese consumers (Giles et al, 2019). It also resulted in product reformulation where taxes exceeded a minimum threshold, leading to a reduction or removal of sugar or fat content (Wright et al, 2019).
Food labelling could improve to steer people towards healthy choices. Currently, mandatory nutrition label standards and regulations refer only to EU regulations and provide nutritional information on the back of the pack. But more can be done at a national level. Front-of-pack labels can be more effective in influencing people’s dietary choices (OECD, 2019). For example, Sweden operates the Keyhole logo, a voluntary scheme, that allows business to label products if they have less fat, sugar or salt, dietary fibre and whole grains, compared to other foods in the same category. In France and other EU countries, businesses can voluntarily apply a Nutri-Score label based on a five-colour scale that summarises the healthiness of a product, and provides a single, compound score (OECD, 2019). This can be particularly effective in encouraging healthier food choices (EUPHA, 2023). There are no health warnings on food products in Poland. For example, as part of its mandatory labelling system for pre-packaged foods, Chile requires products that exceed calorie, salt, sugar, or fat thresholds to have health warnings. Nutritional information should also be extended to restaurant menus as this can also help lower calorie intake (OECD, 2019).
Physical exercise, another key determinant of obesity, needs to increase. Insufficient levels of physical activity can make chronic health conditions, such as cardiovascular disease, diabetes, and back pain, more likely. While some people exercise enough, only a fifth of Poles exercised 150 minutes per week or more in 2019, a minimum threshold for sufficient physical activity recommended by the WHO (Figure 2.29). Physical exercise among adolescents is also insufficient, despite around half of adolescents participating in sports, and appears to have fallen over time (OECD/WHO, 2023e). In 2022, a little under 15% of 15-year-olds exercised at least one hour per day recommended by WHO, around the OECD average (OECD/WHO, 2023e).
Poland’s policies on physical activity could be broadened and better coordinated. The National Health Programme 2021-25 contains objectives on obesity, which includes physical activity, while the National Sport Development Programme 2020 sets out explicit goals and actions on boosting physical activity. The latter has been managed by the Ministry of Sport and Tourism and has been designed well. It is based on previous evidence and is evaluated on an annual basis (Romanowska et al, 2022). However, the programme has not been updated since 2020. Moreover, it narrowly focuses on sport but not on other areas such as transport or health. There is no established coordination with the other ministries such as the Ministry of Health, Ministry of Education and Science, or the Ministries of Infrastructure, Investment and Development, and Environment (Romanowska et al, 2022). Poland should update its sport development programme and broaden it in cooperation with other relevant ministries.
Share of adults spending at least 150 minutes per week on physical activities, 2019
Note: Adults defined as people aged 18 years old and over. Sufficient physical activity is defined as attaining at least 150 minutes of moderate intensity physical activity per week, or more than 75 minutes of vigorous-intensity physical activity per week. 1. 2017 data. 2. 2020-22 data.
Source: OECD Health at a Glance EU 2022.
Raising physical activity levels among adolescents is important. The national curriculum makes physical education mandatory and regular evaluations ensure it meets the prescribed quality standards. Polish children spend 3-4 hours on physical education per week in primary school and 3 hours in secondary school. This could be increased. For example, in Hungary daily physical education classes were made mandatory since 2015. Several national programmes support schools in organising and promoting extracurricular sports such as the “School Sports Club” that offer additional sports supervised by teachers or “Klub” that encourages local sports clubs to offer physical activities to children and adolescents. Sport facilities are cheap or free to access for young people (WHO, 2021). These efforts have continued in 2024 as the authorities allocated PLN 300 million to the “Active School” programme. This is a joint programme by the sports and education ministries and seeks to make sports facilities available outside of school hours such as in the evenings, on weekends and during holidays for both students but also entire families (MEN, 2024). This should encourage more physical activity, particularly as parents’ levels of physical activity can influence their children’s behaviour (Górna et al, 2023). However, the programme could be made more comprehensive to expand opportunities for children to move before, during and after school. Estonia’s Schools in Motion programme also tries to make classes and travel to and from school more active. This approach could benefit Polish schools as there is scope to boost outdoor education (Michalak and Parczewska, 2022).
Existing policies to boost physical exercise among adults should focus more on active travel. Workplace-based interventions are increasingly considered as an effective tool to influence lifestyle (OECD/WHO, 2023e). The National Centre for Workplace Health Promotion and the Central Institute for Labour Protection support health promotion in companies. In 2019, only 7% of people in Poland used a bicycle or scooter as their main mode of transport, which was higher than in most European countries but lower than in neighbouring Germany (EC, 2020). This has been roughly unchanged since 2014, despite the length of bicycle lanes expanding by two thirds over that period (Wolniak, 2023). In 2020, the “Active at Work” campaign promoted active travel to work and aimed to raise awareness in companies about physical activity in the workplace. More needs to be done to encourage cycling. Supported by EU Structural Funds, Poland plans to invest almost EUR 800 million over 2021-27 to develop the cycling network further. This should be complemented by informational campaigns to boost cycling to work and a government-sponsored cycle to work scheme introduced in other OECD countries like the United Kingdom.
Preliminary estimates suggest that Poland has spent 7.0% of GDP on healthcare in 2023, higher than in previous years but still below the OECD average. Healthcare spending per capita, adjusted for purchasing power parity, rose by around two thirds from 2010 to 2022, but it has been broadly flat as a share of GDP for most of that period (Figure 2.30, A). Poland has historically been one of the lowest healthcare spenders in the OECD (Figure 2.30, B). Around three quarters of spending, normally accounting for around 4.5% of GDP, has been funded publicly. The rest has been financed privately through voluntary healthcare insurance accounting for 7-8% and out-of-pocket spending that accounts for almost 20% of spending on healthcare. However, living standards are rising and the population is ageing, adding to pressures on health costs through rising demand. Around a fifth of the population was 65 years and older in 2021 and this is set to rise to 30% in 2050, above most OECD countries (OECD, 2023a). As real incomes grow, the demand for more and better healthcare will also rise. To help address this, preliminary data indicates that public spending on healthcare has risen by 1 percentage point since 2022 to 5.7% of GDP in 2023. The government has pledged to raise public health spending to 7% of GDP by 2027, which will bring total health expenditure closer to 2023 OECD averages.
Total healthcare spending as a share of GDP
Source: OECD Health Statistics.
Ensuring balanced healthcare finance
Public spending on healthcare has risen rapidly and was mostly concentrated on addressing workforce issues. Around half of the committed increase of 2% of GDP over 2022-27 had already occurred by 2023. Recent increases in spending have mostly focused on raising salaries to alleviate labour shortages in healthcare and automatic wage indexation will broadly ensure that the rise in spending, as a share of GDP, will last. Preliminary data for 2024 suggest that public spending has already reached last year’s levels in October and, at this rate, could add up to 6.8% of GDP in 2024 which represents an upside risk to public finances. Given the need for fiscal consolidation, any further increases in spending should focus on priorities, and will need to be delivered in a cost-effective way across a range of health areas to best improve health outcomes. Broadening spending on policies in key areas that are recommended in this chapter would add an additional 0.5% of GDP to health spending, less than the government’s planned increases, and higher alcohol excise duties and efficiency savings from consolidating the hospital network could bring in 0.4% of GDP in higher revenues and lower costs. It is important that spending is raised cautiously and is conditional on reforms and efficiency gains to ensure that it leads to more healthcare services and improvements in quality. In this regard, ensuring sufficient capital investment will help raise quality. This would maximise the effects of higher healthcare spending and, in the context of the need to consolidate, would help balance other spending priorities. Further ahead, expanding long-term care could require significant public support depending on which model is adopted.
Revenues should be broadened and diversified to support additional public healthcare spending. Public health insurance is mainly financed by social contributions paid by workers and pensioners. This makes up around 80% of the public health budget operated by the National Health Fund, while the rest is financed through general taxation. The National Health Fund is under pressure, risking reduced access to health services. The Fund only receives 2-3% of its total revenue from general taxation to cover almost a quarter of patients that are non-contributing members, mostly dependants. In addition, the 2022 amendment to the Act on Medical and Dental Professions has given the Fund additional financing responsibilities for emergency medical care and medicines for people over 75 and pregnant women, among others. There is a range of options to increase funding, such as raising social contributions, higher transfers from general taxation, and higher user costs. It might be preferable to rely more on government budget transfers that are funded by general taxation, including through health taxes, partly to adequately reflect the cost of non-contributing members but also because general tax revenues are more progressive and less distorting to growth as they are not just based on wages. This should, however, not be allowed to weaken incentives to finance the health system on a sustainable basis.
Private insurance could be further developed as an alternative to public funding, but it carries risks in a system that has largely been publicly financed up to now. More private voluntary health insurance, mainly used to supplement public insurance and gain faster access to and better quality of outpatient services, could worsen equity and access. Private healthcare insurance schemes can also have negative externalities to the extent that less complex and healthier patients are diverted to private providers and more expensive treatment is left to public healthcare services. This is more likely to be the case where private insurance is supplementary, such as for specialist consultations and diagnostics, rather than dentistry where private insurance is mostly complementary. Raising VAT on private healthcare services, which are currently exempt, in areas where private healthcare competes with the public sector, could mitigate this and would reduce the subsidy for wealthier households. While out-of-pocket payments are already relatively high, they could be raised if vulnerable social groups are financially better protected.
Capital expenditure in the healthcare sector is relatively low. The healthcare infrastructure is poor and the availability of specialised medical equipment in Poland is lower than in most European countries (OECD, 2023a). The total capital stock per capita in the health sector is estimated to be one of the lowest in the EU (EIB, 2019). Poland invests around EUR 2 billion per year in the health and care sector, accounting for 0.3% of GDP, lower than the EU average of around 0.6% (Figure 2.31). National funds are supplemented by EU funds, which significantly support the healthcare infrastructure development. EU Cohesion Policy programmes will contribute around EUR 2 billion while the EU RRP will fund around EUR 4 billion of investment in healthcare infrastructure, digitalisation, and R&D over 2021-2027. But, the RRP has been delayed by two years, risking incomplete implementation of envisaged projects. Moreover, Poland has been investing less per capita than Czechia, Slovakia or Hungary over the past decade despite having a lower capital stock (EIB, 2019). Healthcare investment, driven by national funds, should be raised and sustained.
Gross fixed capital formation in the health and social care sector as a share of GDP, 2023 or latest year
Source: Eurostat.
Expanding long-term care
The demand for long-term care is rising as the population ages, and the government can play an important role in providing care. Older Poles are more likely to report being in poor health than their peers in most other OECD countries, particularly among lower income groups. Around 27% of the people aged 65+ are limited in their daily activities and many require social care to help with daily life. The share of the 65+ population is projected to rise 50% by 2050 while the population aged 80+ will more than double. The number of people requiring care is likely to rise to around 1.8 million (OECD, 2023a; 2024b).
However, the supply of health and social long-term care is low and cannot meet existing demand. Around 40% of older people have unmet care needs, higher than in other EU countries (OECD, 2024b). But only 13% have access to formal care, evenly balanced between institutional homes and home care, due to supply constraints. The number of beds in residential long-term care facilities is low and about four times smaller than the OECD average. Access is limited and only 1% of older people are in long-term care institutions, compared to the OECD average of 11.5%. Nearly one fifth of municipalities had no access to long-term residential care in 2019. The number of long-term care workers is five times smaller than the OECD average, which severely limits the provision of both institutional and home care. Instead, most long-term care is private and informal. This is predominantly provided by family members, mainly women, who tend to decrease their labour supply due to caring responsibilities (OECD, 2023a).
Spending on long-term care was 0.5% of GDP in 2022, among the lowest in the OECD (Figure 2.32). Spending is substantially higher in some OECD countries with similar levels of income and demographics, such as Slovenia and Czechia, and ranges between 1.5% and 1.9%. Public support tends to be a key pillar (Box 2.6). Spending needs for long-term care in Poland are projected to double by 2050, three times faster than the EU average. Population ageing is projected to increase public spending on long-term care by 3.5 percentage points of GDP by 2050. Boosting coverage to 60% would add a further 3.8 percentage points (OECD, 2024b). A long-term approach to expanding long-term care is required. As part of its health strategy, Poland is creating a system of adequate financing, developing a quality framework for long-term care services, improving the coordination of health and social institutions, and providing support to informal carers. Reforms should be comprehensive to ensure long-term care is sustainable.
Share of GDP, 2023 or latest year available
Note: 1. Countries not reporting spending for LTC (social). In many countries this component is therefore missing from total LTC, but in some countries it is partly included under LTC (health). 2. Country not reporting spending for LTC (health).
Source: OECD Health Statistics database.
Long-term care is provided by a diverse set of stakeholders such as nursing homes, healthcare institutions, and families. Home care tends to be more cost effective while institutionalised care, provided in a care home or hospital, tends to be expensive. The direct cost of informal care provided by households is low, but it is less efficient than formal home care. The importance of each varies across OECD countries. Poland spends 0.5% of GDP on long-term care, mostly health related, of which 13% is on nursing homes and 7% on hospitals. Around 70%, is provided informally by households. Other OECD countries provide more institutional and home care compared to Poland (Figure 2.33).
Long-term care spending by provider, 2022 (or nearest year)
Notes: 1. Countries not reporting social LTC. The category “Social providers” refers to providers where the primary focus is on help with IADL or other social care.
Source: OECD Health Statistics.
Most long-term care is supported through public funding and compulsory social insurance, although the share of public funding varies across countries. For example, public funding accounts for around 70% of total long-term care spending in Slovenia and Austria, and around 90% in Denmark and the Netherlands. Spending on long-term care tends to be predominantly focused on health but some OECD countries also spend on social support such as personal care services to help with daily living activities.
Most OECD countries finance long-term care spending from a number of sources. Public funding relies mainly on long-term care insurance in a few countries such as Belgium, Germany, Japan, Korea, and the Netherlands. In Germany, a share of future long-term care costs is pre-funded from current contributions. Other OECD countries rely on taxes only or on a combination of social contributions and taxes. In Scandinavian countries, central government funds are distributed across municipalities based on income and needs. Private funding for long-term care mostly comes out-of-pocket. Private insurance is available in the United States and Japan, but it only covers a fraction of the costs. Reverse mortgages and home equity schemes exist in the United States, United Kingdom, France, New Zealand, Spain and Canada, but are not used widely and are often concentrated in areas with high real estate prices.
Source: OECD (2020b), OECD (2022b).
Poland should develop institutional health and social care to meet existing and future needs. This implies higher funding, but also the development of institutions, facilities and a suitable workforce. Given the relatively high number of hospital beds, smaller hospitals should be converted to residential long-term and geriatric care facilities as planned in the RRP. Private care homes can play a role although their quality, which has been variable in the past, needs to be better monitored (Sowa-Kofta, 2018). The development of social assistance in day care homes has been supported by the Senior+ programme with over a thousand homes created since 2015 in areas with higher shares of older and lower income people. The programme is continuing until 2025, but only serves 25 000 people and remains small. The expansion of institutional health and social care needs to be accompanied by more long-term care nurses and care workers. However, employment conditions are not very attractive and could be improved. Salaries in the health and social care are low at around 60% of the national average wage and 40% of the contracts are temporary (OECD, 2020a). Training more nurses and care workers will be necessary. Targeted campaigns to change gender stereotypes and recruit more men, such as done in Norway and the UK, could help.
Home-based care will need to be further developed and better supported. Many older people are not fully independent and require assistance with daily living. Personal care provided at home is mostly provided informally by family members and, to a smaller extent, formally by nurses or care workers. However, families have been getting smaller and more dispersed while female participation in the labour market has been rising, which reduces the potential number of carers. Moreover, there are opportunity costs to informal care, it is relatively less efficient, and it exacerbates gender inequalities. Working-age people, typically women, substantially reduce their working hours during periods of informal care, which mostly last more than a year. They suffer income losses and do not make contributions to their pensions. The opportunity costs are estimated at 3.3% of GDP at a cost of 0.2% to the public budget (EC, 2021).
Benefits for home-based care should be more flexible and better targeted. Support for people who did not get a place at a residential long-term care facility or have lesser caring needs, is small and not flexible. Family members who care after disabled older adults are eligible for a monthly care allowance of PLN 520 if family income is low, but they must resign from employment and not work during the period of care. Around 25% of informal carers receive an allowance and the benefit level is low. People older than 75 years get a nursing supplement but, at PLN 215.84, it is very low. The Care 75+ programme subsidises social care services for the older population in rural areas and smaller towns since 2018, but it only helps around 100 000 people. Benefits could be better targeted and more explicitly based on an assessment of different degrees of need as is done in Germany and Slovenia. The needs-based benefits could then take income into account to ensure they are sufficiently generous to provide adequate access to health or social long-term care assistance based on the ability to pay but help avoid poverty. In France, the ability to pay can be based on wealth and deferred until death if income is low. Recipients should also choose their care, whether it is a family member or a personal carer, who should be registered. For example, Belgium has a voucher scheme that allows benefit recipients to purchase declared home-care services.
Support services should be improved to reduce the burden on families and avoid excessive reliance on care homes as demand increases. The overall care allowance should be raised while standardising pay, and employment conditions can improve the working environment. People caring only after their family members should receive training while professional personal care workers, such as nurses, live-in or informal carers, should be registered, trained and licensed to improve the quality of care. In Poland, nurses are trained but there are no requirements for carers. For example, in Austria live-in carers are required to complete a home help course while in Denmark professional personal carers must have at least a 2.5 years degree in social and healthcare assistance. This can be enforced by requiring contracts are conditional on these standards. Making employment in home care more attractive can boost the number of domestic care workers to an extent, but it is unlikely that higher wages will be able to compete with Germany where many Polish people work in the long-term care sector. A recent strategic review has identified additional support for informal carers as a policy priority (MZ, 2024d). Poland will also need to rely on immigration if it is to significantly boost the number of professional personal carers.
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