What next after the ‘commercialization’ of public hospitals? Searching for effective solutions to achieve financial stability of the hospital sector in Poland

Abstract The problem of hospital indebtedness has fraught the Polish health care sector for many decades. While it is largely attributed to the shortcomings of the legal form of the independent public health care unit (SPZOZ), which is the main legal form in which public hospitals operate in Poland, analysis of hospital indebtedness shows that the problem had been apparent before this legal form was introduced in 1999. The problem also did not appear to diminish with the transformation of the SPZOZs into Commercial Code companies, which effectively started in 2011 and was recently halted. While the shortcomings of the legal forms (SPZOZ and others) in which public hospitals operated did contribute to the accumulation of debts in the hospital sector, limited public spending on health and certain reforms were also to blame. Further, repeated rounds of debt reduction financed by the state have likely instilled the conviction among the hospital directors that debts would always be cleared eventually and provided little incentive for prudent financial management. While the government has recently pledged to increase public spending on health, this alone does not guarantee to resolve the problem of hospital indebtedness. Other key changes, such as implementing rational financial management in the hospitals and shifting more care from hospitals to primary and long-term care, are also needed.