Janusz Cieszyński reacts after Business Insider's text. “The diagnosis is correct in one point” [OPINIA]

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How much do the raises really cost?

The article refers to estimates according to which “this year alone, the effects of the increase bill are approximately PLN 72 billion”, and also refers to the calculations of Marek Wójcik, an expert of local government corporations, who in 2022 predicted a cost of PLN 14.4 billion for 2023, while in fact “the increases cost PLN 26.5 billion”.

However, these numbers are not facts, but only a government narrative reinforced by the voice of the outsourcing and pharmaceutical industries. So what do the facts look like regarding the costs of the pay raises for health care workers, which are mentioned in the Pay Increase Act?

Every year Minister of Health receives from the Agency for Health Technology Assessment and Tarification (AOTMiT) to choose from several options for financing pay changes.

Option one – the cheapest — covers only the costs of salary increases for employees under employment contracts provided for in the Act. Further variants add an increase in contractors' salaries, an inflation adjustment, an increase in the valuation of services and support for hospitals.

The Ministry of Health chose the most expensive option each time. The analysis of four subsequent AOTMiT recommendations shows the scale of this phenomenon: cumulative costs in 2022–2025 amounted to PLN 65.69 billion, of which salary increases alone amounted to only PLN 36.55 billion. The remaining PLN 29.14 billion – almost half – are the government's decisions to expand financing, which are then attributed to the “raise bill”.

When the article states that the costs of the increases “consumed PLN 26.5 billion” in 2023, one key caveat is missing: the lion's share of this amount is not the cost of increasing the minimum salaries of nurses and paramedics, but the cost of the ministry's decision simultaneously increasing the valuation of benefitsthat are used by everyone – including the highest-earning B2B contractors.

It might as well be possible to add to this bill the costs of purchasing a tomograph used by medics covered by the act.

Contractors: the real beneficiary of the system

The article rightly notes the scale of “salary chimneys” – we are talking about contractors issuing invoices for over PLN 350,000. PLN per month (compared to PLN 100,000 in 2021). However, there is no connection between this phenomenon and the mechanism for implementing the Act. And the connection is direct.

The money “for the raise bill” goes to hospitals not as a deliberate addition to the wage bill of full-time employees, but as an increase in the valuation of settlement points, lump sums and correction factors. Higher valuations increase revenues for hospitals as a whole — and those revenues fund all forms of employment, including B2B contracts. A contracted physician who negotiates an hourly rate under conditions of staff shortage is the direct beneficiary of any increase in valuations.

The data I obtained as part of the parliamentary inspection from AOTMiT confirm this clearly: specialist doctors on contracts earn more than full-time employees in each decile of the wage distribution. In the median, the difference reaches almost 10,000. PLN per month (PLN 25.8 thousand on a contract versus PLN 15.9 thousand on a full-time job). Among the 10 percent for the highest earners, the difference is even higher – 57.8 thousand. PLN on the contract compared to PLN 38.5 thousand full-time.

The act was intended to protect the least paid full-time workers. The mechanism of its implementation meant that those who did not need protection benefited more. It is worth noting that changing this pathological mechanism does not require any statutory changes from the Ministry of Health – it can be done even this week.

Read also: This is how much they pay doctors and nurses. The numbers are still shocking and will rise again in July

The system spends billions without knowing who they go to

The article rightly criticized politicians for their lack of action, but it did not address the fundamental issue: why doesn't the system pumping out billions know who they go to?

AOTMiT itself – the institution recommending how to divide funds – admits in response to my parliamentary inspection that it does not have reliable data on the real remuneration of contractors. Recording B2B contracts usually comes down to posting an account, the amount of involvement is not reported, and the forms of remuneration are so diverse that they cannot be reduced to the amount of full-time employment.

Every year, the government chooses the most expensive variant of the AOTMiT recommendation, having no idea about the real consequences of this decision. He does not know what part of the increase in valuations translates into an increase in full-time salaries (the purpose of the act) and what part goes into B2B contracts (which is not the purpose of the act). And then the law is blamed for the entire cost.

Cuts that throw the baby out with the bathwater

Since the government does not want to fix the mechanism of spending money, it has one tool left: cuts. And this brings us to what's happening now.

Instead of continuing on the path chosen at the end of 2025, when overestimated valuations were reduced, among others. in diagnostic imaging, it was decided to charge the patients with the costs of subsequent changes. The currently proposed cuts in diagnostics are a mistake – they affect the availability of tests for patients, instead of addressing the real causes of the hole in the National Health Fund budget.

A similar logic lies behind the idea of ​​​​closing half of maternity wards in Poland. At the same time, it is argued that small maternity wards have no chance of being balanced. So how do we explain that According to data for 2024, no maternity ward in the Warmian-Masurian Voivodeship earns money? Neither large nor small, neither municipal, nor district, nor even provincial.

This is not a problem of mismanagement by hospital directors. This is a problem of valuations that do not cover the real costs of running a branch. The same valuations that allow the kings of life in health care to issue invoices for hundreds of thousands of zlotys per month. A map of at-risk departments, along with data on the number of births and financial situation, is published at porodowki.januszcieszynski.pl.

Who really provided the money?

The article also claims that the Minister of Health in the Law and Justice government, Adam Niedzielski, is responsible for this whole mess. He is presented as the author of the raise bill in its current version and the person responsible for “hitting the financial foundations of health care” by transferring the costs of rescue services, vaccines and free medicines for 65+ people from the state budget to the National Health Fund. However, this is not even a simplification, but manipulation.

Firstly, Adam Niedzielski also guaranteed record financing for health care. Increase in health insurance premiums, target 7%. GDP for health is its achievements on the revenue side, which, with a reasonable policy, would allow for balancing expenses. The story about the transfer to the National Health Fund is a myth – previously, the National Health Fund received targeted subsidies for the same purposes, which after 2022 were replaced by one large subjective subsidy, which this year may amount to over PLN 30 billion.

Secondly – and this is crucial – Niedzielski gave money because he had it. He knew that his boss, Prime Minister Mateusz Morawiecki, would provide him with funds for the commitments he has made. It was no accident that the problems began after the change of government. Then the “leaky bucket” narrative and populism returned, the apogee of which was the vote of Health Minister Izabela Leszczyna in favor of… taking away funds from the health insurance premium.

And here we come to the point: Minister Izabela Leszczyna continued to choose the most expensive variants of the AOTMiT recommendationnot having the money that Niedzielski had. What's more, it extended the free medicines program to private offices. This costs several hundred million a year and is a step in the wrong direction, as it leads to the loss of integrity of the support system for seniors.

If anyone is to blame for the hole in the National Health Fund, it is Leszczyna, who gave money she did not have to pay off political debts and not make difficult decisions. It was not Niedzielski who left the “trap” – it was his successors who fell into it of their own free will, without making any attempt to correct the new financial reality.

What's next? The mechanism can be repaired instead of punishing full-time workers

The article ends with a question: who is responsible for the system that stopped working? The answer is not as simple as this text suggests. The 2017 Act, which gave medics decent minimum wages, is not responsible for this. They correspond to koil ministers who abandoned the reasonable management of funds for raises and lost control over the increasingly higher salaries of doctors. Doctors, who are hardly surprised – each of us would accept a generous raise if only we were offered such a raise.

Instead of freezing the wages of nurses and paramedics – which amounts to punishing full-time workers because contractors earn too much – the government should: separate the cost of full-time pay raises from benefit valuations in AOTMiT recommendations.

Should change the mechanism for implementing the act so that the money goes specifically to full-time positions and not to valuations in general, as well as create an electronic system for recording contracts with medical staff and introduce transparent rules for concluding contracts financed from public funds.

The key question today is: what will the Minister of Health do in June when the time comes to decide on the indexation formula? Will he choose the most expensive option again and then blame the law? Will it freeze all wages and expose us to the outflow of doctors to the private system? Will someone finally decide to fix the mechanism instead of blindly cutting funds for the treatment of Poles?

The answer to this question will determine whether the health care crisis will deepen or whether we will finally begin to solve it.

Author: Janusz Cieszyński, expert of the Sobieski Institute, former deputy minister of health, PiS MP