Poland’s National Health Fund (NFZ) is changing how it finances diagnostic tests exceeding contracted volumes, effective April 1st, 2026, while prioritizing oncology patients.
NFZ Overrun Funding Rules Change
The NFZ has issued a directive altering the financing of diagnostic overruns. A draft regulation published in March 2026 concerns diagnostics performed in outpatient settings.
The change maintains unlimited billing for these services, but the NFZ will now fund any diagnostic test exceeding the contract value at a decreasing rate. Payments for services exceeding the contract value will be made after the year’s end.
Public Consultations and Adjustments
Public consultations lasting two weeks resulted in adjustments to the proposed rate, increasing it from an initial 40% to a revised level. The implementation of the changes was also postponed to the second quarter of 2026.
The new billing model will apply to services provided from April 1st, 2026. Services performed in the first quarter of 2026 will be billed under the existing rules.
Priority for Oncology Patients with DiLO Cards
Diagnostic services for patients with a Cancer Diagnosis and Treatment Card (DiLO) are unlimited and funded through a separate oncology budget, distinct from the altered outpatient diagnostics funding.
Jakub Szulc, Vice President of the NFZ, emphasized that the DiLO card mandates adherence to specific timelines for diagnostics and treatment initiation.
The NFZ stresses that the DiLO card should be issued to patients already suspected of having cancer.
Restoring Priority to Oncology Patients
Filip Nowak, President of the NFZ, stated that the implemented solutions aim to restore priority to oncology patients, helping integrate those currently outside the DiLO system into a faster oncology pathway.
Rising Healthcare Costs and Funding Challenges
Year-on-year healthcare funding has increased, but expenditures are growing at an even faster rate. The NFZ budget exceeded 100 billion złoty in 2021 and is projected to surpass 200 billion złoty in 2026.
The Fund faces increasing costs for unlimited services, the scale of which is difficult to accurately estimate during budget planning.
Ambulatory Specialist Care accounts for the largest share of unlimited services. The number of services performed in this area has increased by only 20% over the years, while their value has risen by 152%, resulting in a disproportionate cost increase.
Dynamic Expenditure Growth
The average cost of healthcare services has risen significantly over the past four years (2021-2025).
The dynamic growth in expenditures is influenced by wage increases in public healthcare, guaranteed by legislation, which directly impacts the Fund’s budget. In 2026, the cumulative cost of AOTMiT recommendations, covering wage increases, will exceed 70 billion złoty, representing over one-third of the NFZ’s total funds.
Jakub Szulc, Vice President of the NFZ, explained that the changes are intended to provide employers with tools to control escalating medical labor market rates and ensure rational spending within the available budget.
New Expert Team and Service Monitoring
The NFZ will monitor the implementation of the changes to assess their impact on patient care. A special team of experts, including Professor Edyta Szurowska, national consultant in radiology and imaging diagnostics, is being formed.
The team will develop standards for referrals for selected imaging tests and guidelines for the description/interpretation of radiological examinations for specific indications.
NFZ Control Findings
An NFZ audit revealed instances of facilities performing multiple, closely spaced MRI or CT scans on patients with requests for scans of several spinal segments, requiring separate referrals. In practice, such a scan should ideally be performed once, based on a single referral, covering multiple areas. This irregularity was found in over 8,200 MRI scans out of 12,000 reviewed, resulting in additional costs and multiple visits for patients.
This practice led to an overpayment of over 1 million złoty on nearly 4.9 million złoty spent on approximately 12,000 controlled MRI scans. The audit also found that the facilities themselves were influencing the allocation of referrals.
Financial Impact of Changes
The changes in funding for diagnostic overruns for four cost-intensive outpatient diagnostic services (ASDK) are expected to free up approximately 625 million złoty, maintaining priority access to services for oncology patients with DiLO cards, children, and patients requiring urgent medical intervention.
[https://www.nfz.gov.pl/zarzadzenia-prezesa/zarzadzenia-prezesa-nfz/zarzadzenie-nr-342026dsoz,7931.html]