In OECD countries in 20221outlays on health care, defined as health services and prevention were estimated at 9.2% of GDP, compared with 9.7% in 20212. In European Union states, this figure was 8.9% of GDP in 2022 versus 9.4% of GDP in 2021.
Average health expenditures in OECD countries per capita, by purchasing power parity, reached $4,986 in 2022. Among OECD countries, after adjusting for differences in purchasing power, the United States had the highest spending on health care with USD 12 555 per capita (16.6% of GDP), followed by Switzerland with USD 8 049 (11.3% of GDP) and Germany with USD 8 011 (12.7% of GDP). Mexico, Colombia and Costa Rica are estimated to have the lowest per capita health care spending at $1,181 (5.5% of GDP), $1,640 (8.1% of GDP) and $1,658 (7.2% of GDP), respectively.
In this breakdown, health care spending in Poland is at $2,973 (6.7% of GDP) and, despite year-on-year growth of nearly 18%, this remains below the European Union average ($4,639).³ Compared to EU states, Poland’s outlays on health are among the lowest in, surpassing only Hungary, Slovakia, Croatia, Bulgaria and Romania.
According to an OECD report, in 2023 the ratio of practicing physicians per
1 000 citizens in Poland was 3.4 with an average of 4.1 for the EU as a whole.
The index of nurses in Poland was also unfavorable, at 5.7 per 1,000 population compared to 8.5 per 1 000 in the EU as a whole. Europe's health care workers are facing a serious crisis. Twenty European countries see a shortage of doctors in 2022 and 2023, while fifteen countries have reported a shortage of nurses. According to an estimate based on minimum employment thresholds for universal health insurance, there is a shortage of about 1.2 million doctors, nurses and midwives in EU Member States in 2022. The main reasons for this shortage are the demographic challenges of both an aging population, which increases the demand for health services, and an aging healthcare workforce, which intensifies the need to replace healthcare workers as they retire. More than a third of doctors and a quarter of nurses in the EU are over 55 and are expected to retire in the coming years. At the same time, interest in a career in healthcare is declining among young people, with interest in nursing declining in more than half of EU Member States between 2018 and 2022. Health workforce planning is essential for shaping policy and ensuring a sufficient number of health workers and their qualifications.
The OECD estimates that Europe is facing a profound demographic shift, with the percentage of people over 65 in the EU expected to rise from 21% in 2023 to 29% by 2050. Life expectancy at age 65 now exceeds 20 years, but more than half of that is accompanied by chronic disease and disability.
In terms of infrastructural resources, assessed as the number of hospital beds per 1,000 people, the OECD report states that Poland had a pretty high ratio of 6.3, with an OECD average of 4.3. Among Poland’s EU neighbors, the resources were greater in Germany (7.8), the Czech Republic (6.7), and slightly smaller in Slovakia (5.7) and Lithuania (6.1). What may come as a surprise, is the very low said rate in the US, UK, and Sweden (2.8, 2.4 and 2.0, respectively) may come as a surprise, but hospital stays in these countries are short. In turn, Japan’s hospital bed ratio was at a record high of 12.6, but there, hospital stays are twice as long as in Europe, where people stay four or five days.
Despite universal health insurance in most OECD countries, there are still some barriers to accessing health care, as gaps in financial protection make it impossible for low-income households to afford health care. Out-of-pocket payments account for nearly onefifth of health care spending in OECD countries. People in the lowest income quintile are, on average, three times more likely to delay care or not seek assistance compared to those in the highest income quintile.
The health care market in Poland
The health market in Poland is a growing and promising business area, both in the public and private payer areas. Its most important segments include services financed by the National Health Fund, fee-for-service (FFS), medical subscriptions, health insurance, and drug and non-drug expenses⁵.
Market value
Healthcare expenditures in Poland, excluding purchases and reimbursements for drugs and non-drugs, amounted to more than PLN 190 billion in Poland in 2023, of which PLN 35 billion is for private healthcare services, and PLN 157 billion is financed by the National Health Fund, particularly in the segments of hospital care, outpatient specialist care services, and primary health care services.
According to PMR, a market research and analysis firm in Central and Eastern Europe, the private healthcare market for fee-for-service products was expected to be worth PLN 26.3 billion by the end of 2023 (up 12.4% y/y). In 2023, the value of the subscription market (medical subscriptions and supplementary health insurance) in the private healthcare market will be PLN 8.8 billion (+21.7% y/y), of which the value of medical subscriptions is PLN 7.1 billion (+19.3% y/y) and the value of the private health insurance market more than PLN 1.7 billion (+33.1% y/y). Spending on drugs and non-drugs amounts to app. PLN 44.4 billion.
As of mid-2023, the National Health Fund increased valuations of services in specialized outpatient care. This has a positive effect on medical centers offering healthcare services under public financing. According to PMR, medical inflation will be an important factor affecting the value of the private healthcare care market. The trend of growing prices, visible since 2022, will be maintained in the coming years, the above aspects will be particularly important for the prices of outpatient care and physician services. The healthcare services market (fee for service, subscriptions, insurance) is sensitive to marked increases in the price of electricity and materials and raw materials, which raise operating costs. In 2023, the growth rate for remunerations in private health care was as high as 13.4% y/y, which was mainly due to remuneration claims of white staff including nurses, physical therapists, physiotherapists, hygienists and dental assistants. The forecast for 2024 presumed a growth of 9.3% y/y.
Health insurance
The number of supplemental health insurance holders is growing every year. The vast majority of people holding these products are group policyholders, although there has been an increase in interest in individual policies since the outbreak of the pandemic. At the end of 2023, there were nearly 4.81 million people in Poland with health insurance, up 14% y/y. In the course of this period, Poles spent nearly PLN 1.7 billion on private policies, up nearly 33% y/y. However, this represented only 2.0% of the total Polish insurance market.
The PMR experts project that total value of the private health care market will increase by over 8.2% to PLN 95 billion in 2025, of which the value of the market excluding medicine and non-medicine expenses will be about PLN 43.5 billion. While in the longer horizon, 2024–2029⁶ :
- the value of the market (excluding drug and non-drug spending) will reach PLN 55 billion in 2029, with a compound annual growth rate (CAGR) of 7.8% from 2024 to 2029;
- the growth rate of private health insurance will reach the average annual level of approx. 12.8% for supplementary health insurance and approx. 8.4% for subscriptions;
- the average growth rate of the fee for service market will be 7.3% per year.
In addition, the following is expected:
- further intensive development of telemedicine and service opportunities through remote channels;
- increasing number of persons outside working age and greater need to provide care to senior citizens;
- increasing public awareness of prevention and periodic examinations; • persistently high inflation of medical services, in particular due to wage pressures from medical staff;
- reducing the materiality of the COVID-19 pandemic factor and its impact on the health market.
PZU Zdrowie’s market position
PZU Życie Health Pillar in the PZU Group) is the leader of the health insurance market in Poland and remains among the largest companies in the overall private health care market, where the main competitors are the LUX MED Group (PLN 4.1 billion in revenue in 2023) and Medicover (PLN 3.8 billion in revenue). In terms of the value of the Health Pillar’s revenues, the PZU Group ranks third among nationwide medical operators with revenues of PLN 1.6 billion in 2023 and PLN 1.9 billion in 2024, an increase of 18.1% y/y.
1. The most up-to-date figures as at the date of publication of the Management Board’s report on the PZU Group and PZU SA’s activity
2. OECD Health at Glance report, Poland: Health System Profile 2023, https://www.gov.pl/web/oecd/raport-na-temat-sytuacji-w-obszarze-ochronyzdrowia-w-panstwach-czlonkowskich-oecd
3. https://stats.oecd.org/Index.aspx?DatasetCode=HEALTH_STAT#
4. OECD „Health at a Glance 2024” Report Health at a Glance: Europe 2024 – European Commission
5. The “medicine and non-medicine expenses” category includes: 1) patient spending on medicines (reimbursed, non-reimbursed Rx and OTC), dietary supplements and other products in pharmacies, and (2) patient spending on OTC medicines and dietary supplements outside of pharmacies (in convenience stores, including grocery stores, gas stations, drugstores, herbalists, herbal and medical stores, specialized supplement stores, sporting goods stores and others), including online sales in e-stores (including e-pharmacies) and sales platforms
6. PMR report, “Private healthcare market in Poland 2024 – market analysis and development forecasts for 2024–2029”