Report No.

52536-PL

POLAND
Public Expenditure Review
(In Two Volumes)
Volume II: Background Papers
March 5, 2010

Poverty Reduction and Economic Management Unit

Europe and Central Asia Region

Document of the World Bank

CURRENCY EQUIVALENTS
Currency unit = euro ()
1.00 = US$1.43
(As of September 30, 2008)
FISCAL YEAR
January 1 December 31
ACRONYMS AND ABBREVIATIONS
ALMP
BGK
CAP
CASE
CG
CIT
CPI
DRGs
EC
ECA
ECSHD
EMS
ERM
ESA
ESSPROS
EUROSTAT
EU
FDI
FISE
FUS
GDP
GG
GIME
GUS
IBS
ILO
IMF
KRUS
LF
LFS

Active Labor Market Programs

Bank of the National Economy
Common Agricultural Policy
Center for Social and Economic Research
Central Government
Corporate Income Tax
Consumer Price Index
Diagnosis Related Groups
European Commission
Europe and Central Asia Region
Europe and Central Human Development
Emergency Medical Services
Exchange Rate Mechanism
European System of Accounts
Europeans Unions System of Integrated
Social Protection Statistics
European Union Statistical Office

LG
MLSP
MoF
MoH
MSHE
MT
MYSFP
MTEF
NBP
NDC
NIK
NGO
NHF
NZOZ
PAYG

Local Governments
Ministry of Labor and Social Policy
Ministry of Finance
Ministry of Health
Ministry of Science and Higher Education
Medium Term
Multi-Year State Financial Plan
Medium Term Expenditure Frameworks
National Bank of Poland
Notional Defined Contribution
Supreme Chamber of Control
Non Government Organization
National Health Insurance Fund
Non-Public Health Care Institution
Pay-as-you-go

OECD

European Union
Foreign Direct Investment
Foundation for Social and Economic
Initiatives
Social Insurance Fund
Gross Domestic Product
General Government
Gdask Institute for Market Economics
Central Statistical Office
Institute for Structural Research
International Labor Organization
International Monetary Fund
Agricultural Social Insurance Fund
Labor Fund
Labor Force Survey

OFE
PER
PISA

Organization for Economic Cooperation

and Development
Open Pension Funds
Public Expenditure Review
Program for International Student
Assessment
Personal Income Tax
Polish Currency (Zloty)
Purchasing Power Parity
Purchasing Power Standard
Poviat Labor Office
Single Area Payment Scheme
Independent Public Health Care Institution
World Economic Outlook
Regional Labor Office
Value Added Tax
Social Insurance Institution

Vice President
Country Director
Sector Director
Sector Manager
Task Team Leader

PIT
PLN
PPP
PPS
PUPs
SAPS
SPZOZ
WEO
WUPs
VAT
ZUS

Philippe H. Le Houerou, ECAVP

Theodore Ahlers, ECCU5
Luca Barbone, ECSPE
Bernard Funck, ECSP2
Kaspar Richter, ECSP2

Statistical Annex
(Data Sources: Staff Compilations based on data from MoF, MoH, NHF, GUS/CSO)
Table 1a: Health Expenditures, 2005 (current prices, PLN million)
Outpatient
Hospitals
Psychiatric care
Rehabilitation
Long-term care
EMS
Drugs
Healthcare policy programs
Other
Total

National Health Fund

5,960.92
14,569.64
1,081.23
1,255.08
515.95

State budget
13.72
714.02
30.79

Local governments
113.82
1,029.95
26.47

8.15
13.24

14.92
24.08

455.17
1,945.74
3,180.82

40.63
933.21
2,183.08

Debt
6,742.60

6,323.26
3,827.94
33,534.02

6,742.60

Total public
6,088.47
23,056.21
1,138.49
1,255.08
539.01
37.32
6,323.26
495.80
6,706.88
45,640.52

Private
3,062.55
180.15

Total public
6,815.54
24,355.83
1,269.31
1,382.19
610.47
137.33
6,695.76
580.11
7,426.50
49,273.05

Private
3,350.02
197.06

180.15
180.15
14,412.00

18,015.00

Total
9,151.02
23,236.36
1,138.49
1,435.23
719.16
37.32
20,735.26
495.80
6,706.88
63,655.52

Table 1b: Health Expenditures, 2006 (current prices, PLN million)

Outpatient
Hospitals
Psychatric care
Rehabilitation
Long-term care
EMS
Drugs
Healthcare policy programs
Other
Total

National Health Fund

6,660.49
15,688.12
1,169.88
1,382.19
578.04

State budget
536.91
27.92

Local governments
155.05
1,350.40
71.52

6.35
56.63

26.08
80.70

528.23
1,999.63
3,155.66

51.88
891.98
2,627.61

Debt
6,780.40

6,695.76
4,534.89
36,709.37

91

6,780.40

197.06
197.06
15,764.80

19,706.00

Total
10,165.56
24,552.89
1,269.31
1,579.25
807.53
137.33
22,460.56
580.11
7,426.50
68,979.05

Table 1c: Health Expenditures, 2007 (current prices, PLN million)

National Health Fund
7,816.58
18,623.13
1,362.63
1,630.35
702.29

Outpatient
Hospitals
Psychatric care
Rehabilitation
Long-term care
EMS
Drugs
Healthcare policy programs
Other
Total

6,727.32
5,394.98
42,257.28

State budget
0.22
637.59
33.03
7.09
2.90

Local governments
162.13
1,403.40
69.01
20.84
58.85

581.23
1,210.77
2,472.83

58.42
881.21
2,653.86

Debt
5,920.40

5,920.40

Total public
7,978.94
26,584.52
1,464.67
1,630.35
730.22
61.75
6,727.32
639.65
7,486.96
53,304.37

Private
3,624.11
213.18

Total public
10,420.04
30,524.34
1,937.04
2,151.58
1,014.20
1,685.96
7,426.88
677.21
10,649.31
66,486.57

Private
4,520.35
265.90

213.18
213.18
17,054.61

21,318.27

Total
11,603.04
26,797.70
1,464.67
1,843.54
943.40
61.75
23,781.94
639.65
7,486.96
74,622.64

Table 1d: Health Expenditures, 2008 (current prices, PLN million)

2008
Outpatient
Hospitals
Psychatric care
Rehabilitation
Long-term care
EMS
Drugs
Healthcare policy programs
Other
Total

National Health Fund

10,137.07
24,918.25
1,781.47
2,151.58
970.11
1,471.28
7,426.88
6,325.19
55,181.82

State budget
0.22
794.55
35.22
7.75
112.05

Local governments
282.75
2,447.45
120.35
36.34
102.63

575.33
2,787.35
4,312.47

101.88
1,536.78
4,628.18

92

Debt
2,364.10

2,364.10

265.90
265.90
21,272.23

26,590.29

Total
14,940.38
30,790.24
1,937.04
2,417.48
1,280.11
1,685.96
28,699.11
677.21
10,649.31
93,076.86

Table 1e: Health Expenditures, 2008 (current prices, PLN million)

Outpatient
Hospitals
Psychatric care
Rehabilitation
Long-term care
EMS
Drugs
Healthcare policy programs
Other
Total

National Health Fund

10,538.80
24,985.87
2,000.64
2,530.17
1,080.30
1,730.50
7,317.59
6,753.59
56,937.46

State budget
0.16
853.46
36.35
7.85
147.04

Local governments
230.35
1,993.89
98.05
29.61
83.61

552.24
1,916.19
3,513.29

83.00
1,251.99
3,770.49

Debt
2,364.10

2,364.10

Total public
10,769.31
30,197.32
2,135.03
2,530.17
1,117.76
1,961.15
7,317.59
635.24
9,921.77
66,585.34

Private
4,527.06
266.30
266.30
266.30
21,303.83

26,629.79

Total
15,296.37
30,463.62
2,135.03
2,796.46
1,384.06
1,961.15
28,621.42
635.24
9,921.77
93,215.13

Table 2: Composition of Health Expenditures (current prices, PLN million)

Outpatient
Hospitals
Psychatric care
Rehabilitation
Long-term care
EMS
Drugs
Healthcare policy programs
Other
Total

2005
9,151.02
23,236.36
1,138.49
1,435.23
719.16
37.32
20,735.26
495.80
6,706.88
63,655.52

2006
10,165.56
24,552.89
1,269.31
1,579.25
807.53
137.33
22,460.56
580.11
7,426.50
68,979.05

93

2007
11,603.04
26,797.70
1,464.67
1,843.54
943.40
61.75
23,781.94
639.65
7,486.96
74,622.64

2008
14,940.38
30,790.24
1,937.04
2,417.48
1,280.11
1,685.96
28,699.11
677.21
10,649.31
93,076.86

2009
15,296.37
30,463.62
2,135.03
2,796.46
1,384.06
1,961.15
28,621.42
635.24
9,921.77
93,215.13

Table 3: Ratio of Health Expenditures in GDP

GDP
State budget expenditure on health
State budget expenditure on health as percentage of GDP
Local governments expenditure on health
Local governments expenditure on health as percentage of GDP
of which: public debt
of which: public debt as percentage of GDP
National Health Fund expenditure on health
National Health Fund expenditure on health as percentage of GDP
Total public expenditure on health
Total public expenditure on health as percentage of GDP
Private expenditure on health
Private expenditure on health as percentage of GDP
Total expenditure on health
Total expenditure on health as percentage of GDP
Population
Public expenditure on health per capita
Private expenditure on health per capita
Total expenditure on health per capita

2005
983,302.00
3,180.82
0.32
8,925.68
0.91
6,742.60
0.69
33,534.02
3.41
45,640.52
4.64
18,015.00
1.83
63,655.52
6.47
38.16
1,196.12
472.13
1,668.25

94

2006
1,060,031.00
3,155.66
0.30
9,408.01
0.89
6,780.40
0.64
36,709.37
3.46
49,273.05
4.65
19,706.00
1.86
68,979.05
6.51
38.08
1,293.78
517.43
1,811.20

2007
1,167,796.00
2,472.83
0.21
8,574.26
0.73
5,920.40
0.51
42,257.28
3.62
53,304.37
4.56
21,318.27
1.83
74,622.64
6.39
38.04
1,401.12
560.36
1,961.48

2008
1,267,000
4,312.47
0.34
6,992.28
0.55
2,364.10
0.19
55,181.82
4.36
66,486.57
5.25
26,590.29
2.10
93,076.86
7.35
38.11
1,744.60
697.72
2,442.32

2009
1,317,000
3,513.29
0.27
6,134.59
0.47
2,364.10
0.18
56,937.46
4.32
66,585.34
5.06
26,629.79
2.02
93,215.13
7.08
38.10
1,747.65
698.94
2,446.59

Table 4a: Profit-Loss Statement of NHF, 2005-2007

Period
2005

Item
A.

B.

C.
D.

E.

F.
G.

Net revenues from sales of products, goods and materials, including:

I.
Net income from products sale - premiums and other for PUZ
1.
from premiums for PUZ
2.
other
II.
Change in products
III.
Cost of goods production for NFZ's purpouse
IV.
Net revenues from sales of goods and materials
Operating expenses
I.
Depreciation
II.
Materials and energy
III.
External services
IV.
Taxes and charges
V.
Salaries
VI.
Social insurance and other benefits
VII.
other
VIII.
Value of goods and materials sold
Gross profit (loss) on sales (A-B)
Other operating revenues
I.
Gain on disposal of non-financial fixed assets
II.
Subsidies
III.
Other operating revenues
Other operating expenses
I.
Loss on disposal of non-financial assets
II.
Revaluation of non-financial fixed assets
III.
Other operating expenses
Profit (loss) on operating activities (C+D-E)
Financial revenues
I.
Dividend and profit sharing
II.
Interest
III.
Gain on disposal of investments
IV.
Revaluation of investments

95

33,844.99
33,842.04
33,792.09
49.95
0.94
0.00
2.01
33,427.80
34.49
12.46
33,159.63
2.35
175.44
36.98
3.78
2.67
417.19
325.90
0.00
0.44
325.47
87.82
0.05
2.53
85.24
655.27
86.75
0.00
79.58
0.00
0.00

Period
2006
37,106.27
37,104.61
37,071.56
33.05
-0.15
0.00
1.81
36,402.52
47.00
12.31
36,106.37
2.29
188.76
39.74
4.02
2.03
703.75
358.35
0.08
0.57
357.70
274.66
0.00
1.53
273.13
787.43
112.70
0.00
96.97
0.00
0.00

Period
2007
43,425.81
43,424.33
42,223.71
1,200.63
-0.79
0.00
2.27
41,747.14
49.51
13.53
41,402.64
2.37
226.24
46.65
3.65
2.55
1,678.67
397.51
0.06
0.58
396.87
474.86
0.00
47.04
427.82
1,601.32
196.88
0.00
149.58
0.00
0.00

K.
L.
M.
N.

V.
other
Financial expenses
I.
Interest
II.
Loss on disposal of investments
III.
Revaluation of investments
IV.
other
Profit (loss) on business activities (F+G-H)
Result on extraordinary events (J.I.-J.II.)
I.
Extraordinary gains
II.
Extraordinary losses
Gross profit (loss) (I -/+J)
Income tax
Other statutory reductions in profit (increases in loss)
Net profit (loss) (K-L-M)

O.

Total revenues

34,257.64

37,577.32

44,020.20

P.

Total expenses

33,534.02

36,709.37

42,257.28

H.

I.
J.

96

7.17
18.40
12.71
0.00
0.00
5.69
723.61
0.00
0.00
0.00
723.61
0.00
0.00
723.61

15.73
32.19
11.41
0.00
0.00
20.78
867.94
0.00
0.00
0.00
867.94
0.00
0.00
867.94

47.30
35.29
10.58
0.00
0.00
24.70
1,762.92
0.00
0.00
0.00
1,762.92
0.00
0.00
1,762.92

Table 4b: Profit-Loss Statement of NHF, 2008-2009

Plan 2008
49,635.52
45,544.54
4,090.98
200.00
200.00

Written gross premium

from ZUS
from KRUS
Revenues from previous year
from ZUS
from KRUS
Premium collecting costs

98.36
90.18
8.18
52,006.80
53,841.85

from ZUS
from KRUS
Net revenues
Operating expenses
Statutory general reserve
Medical services expenses
Outpatient
Hospitals
Psychiatric care
Rehabilitation*
long-term care
drugs
other
EMS
other
Profit (loss) on operating activities (A - B)
Administrative expenses
Materials and energy
External services
Taxes and charges
salaries
Social insurance and other benefits
other
other revenues
Other operating expenses

52,359.43
10,137.07
24,918.25
1,781.47
2,151.58
970.11
7,426.88
4,974.08
1,471.28
11.13
(1,835.06)
539.95
18.78
109.31
3.42
267.37
54.40
86.67
2.80
617.05

97

Plan 2009 (February 2009)

54,272.85
49,721.04
4,551.81
200.00
200.00
107.55
98.45
9.10
56,785.09
55,923.45
542.73
53,649.59
10,538.80
24,985.87
2,000.64
2,530.17
1,080.30
7,317.59
5,196.22
1,730.50
0.63
861.64
619.96
19.45
116.90
3.67
292.38
59.89
127.67
4.25
256.50

Financial revenues
Interest
other
Financial expenses
Profit (loss) on business activities
Result on extraordinary events
Gross Profit (Loss)
Other statutory reductions in profit (increases in loss)
Net Profit (Loss)
Total Revenues
Total Expenses

340.62
340.62

40.56
40.56

84.61
(2,733.25)

30.00

(2,733.25)
(2,733.25)
52,448.58
55,181.82

56,937.46
56,937.46

Table 5: CPI, Poland, 2005-2009

2005
100

Consumer Price Index

98

2006
101.3

2007
103.8

2008
108.1

2009
109.5

Table 6: Distribution of Hospitals and Hospital Beds in Poland

2005

POLAND
Dolnolskie
Kujawsko-Pomorskie
Lubelskie
Lubuskie
dzkie
Maopolskie
Mazowieckie
Opolskie
Podkarpackie
Podlaskie
Pomorskie
lskie
witokrzyskie
Warmisko-Mazurskie
Wielkopolskie
Zachodniopomorskie

total
0.2
0.24
0.17
0.19
0.23
0.23
0.23
0.19
0.2
0.14
0.22
0.17
0.22
0.18
0.27
0.2
0.2

hospitals
pub pvt
0.16 0.04
0.18 0.06
0.12 0.05
0.16 0.03
0.17 0.06
0.18 0.05
0.14
0.1
0.16 0.03
0.15 0.05
0.13 0.01
0.19 0.02
0.13 0.04
0.19 0.03
0.16 0.02
0.17 0.09
0.17 0.04
0.17 0.02

no of beds
total
pub
47.04 44.89
49.01 43.57
43.56 37.35
50.63 49.31
42.87 40.21
53.13 52.01
42.75 41.25
45.68 44.69
39.8 36.67
42.08 41.88
50.79
49.8
38.95 36.47
57.12 55.55
44.67 44.67
42.12
36.7
46.61 44.16
46.28 45.43

2006
pvt
2.15
5.44
6.21
1.32
2.65
1.12
1.49
0.99
3.13
0.2
1
2.49
1.57
0
5.42
2.45
0.86

total
0.19
0.24
0.16
0.17
0.21
0.23
0.19
0.17
0.19
0.14
0.23
0.17
0.23
0.16
0.24
0.19
0.2

hospitals
pub pvt
0.15 0.04
0.17 0.07
0.11 0.06
0.15 0.02
0.16 0.05
0.18 0.05
0.12 0.06
0.15 0.02
0.15 0.04
0.13 0.01
0.19 0.03
0.12 0.05
0.18 0.04
0.15 0.01
0.17 0.06
0.15 0.04
0.17 0.03

99

no of beds
total
pub
46.34
43.9
47.14 39.44
42.43 35.51
50.58 49.05
41.93 38.57
51.28 50.26
42.11 40.37
44.73 44.14
40.06
37.1
42.55
42.3
49.64 48.56
38.13 35.65
56.98 55.05
44.54 43.33
41.53 36.08
45.88 43.41
46.36 45.46

2007
pvt
2.44
7.71
6.92
1.53
3.37
1.02
1.74
0.59
2.96
0.25
1.08
2.48
1.93
1.21
5.45
2.47
0.9

total
0.2
0.22
0.19
0.17
0.22
0.23
0.19
0.18
0.19
0.15
0.23
0.16
0.23
0.16
0.24
0.19
0.2

hospitals
pub pvt
0.15 0.04
0.16 0.06
0.11 0.08
0.15 0.02
0.15 0.07
0.18 0.06
0.12 0.07
0.15 0.03
0.15 0.04
0.13 0.02
0.19 0.04
0.12 0.05
0.18 0.04
0.15 0.01
0.17 0.06
0.15 0.04
0.17 0.04

no of beds
total
publ
45.92 43.24
45.66 38.53
42.33 35.26
50.57 48.72
42.71 36.25
51.56 50.48
41.73 39.66
44.31 43.12
40.71 37.21
42.83 42.38
49.62 48.45
37.42
34.4
55.8 53.69
44.16 42.95
41.1 35.88
45.53 43.24
45.67 44.75

pvt
2.68
7.12
7.07
1.85
6.46
1.08
2.08
1.19
3.51
0.44
1.17
3.02
2.1
1.22
5.22
2.28
0.92

Table 7: Hospitals and Hospital Beds in Poland, 1990-2006

1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006

Hospitals per 100,000

Average length of stay, all hospitals

Hospital beds per 100,000

1.89
1.91
1.89
1.92
1.93
1.93
1.93
1.94
1.93
2.08
2.08
2.15
2.18
2.15
2.21
2.19
2.08

12.5
12.3
11.8
11.4
11.1
10.8
10.6
10.4
10.1
9.3
8.9
8.4
7.9
7.7
6.9
6.7
6.4

660.38
653.1
639.17
638.3
634.22
629.19
622.09
613.32
595.83
580.94
556.38
549.45
557.14
547.04
534.82
523.49
516.17

100

Table 8: Hospitals and Medical Personnel, Poland and Comparator Countries

Hospitals
per
100,000

Slovenia
Hungary
Poland
EU (post 2004)
Slovakia
EU
EU (pre 2004)
Latvia
Estonia
Lithuania

1.44
1.76
2.08
2.58
2.65
2.97
3.1
4.13
4.25
4.89

Hospital
beds per
100,000

Acute
care
hospital
beds per
100,000

466.18
712.55
516.17
625.49
678.84
570.18
554.2
757.13
556.99
813.95

376.74
413.43
410.75
464.84
601.58
...
375.32
523.26
380.2
509.33

Psychiatric
hospital
beds per
100,000

67.79
30.43
64.78
...
82.44
...
...
137.03
56.2
102.29

Nursing
and
elderly
home beds
per
100,000

Physicians
per 100,000

...
85.53
...
...
...
...
...
...
549.91
437.26

237.29
278.02
203.18
253.23
313.25
322.38
337.87
304.91
328.53
406.71

Table 9: Health Expenditures, Poland and Comparator Countries

Country
Estonia
Lithuania
Poland
Latvia
Czech Republic
Slovak Republic
Hungary
Slovenia
EU (2009 classification)

Total Health Expenditure

Public Expenditure on Health

5.2
6.2
6.2
6.6
6.9
7.1
8.3
8.4
9.4

3.8
4.3
4.3
3.9
6.1
5.0
5.9
6.1
7.3

101

Nurses
(PP) per
100,000

764.79
903.85
468.84
557.26
631.6
745.64
804.96
547.95
655.21
734.8

Average
length of
stay, all
hospitals

6.8
7.92
6.4
7.63
8.7
9
9.35
9.44
7.81
9.9

Average
length of
stay,
acute care
hospitals
only
5.51
6.02
...
7.58
7.8
6.51
6.46
...
5.92
6.6

Bed
occupancy
rate in
percent,
acute care
hospitals
only
69.67
69.15
...
70.65
68.3
76.28
...
...
70.9
75.5