How the NFZ pays hospitals: lump sums, points and overperformance.

A hospital rarely receives payment from the National Health Fund (NFZ) for a specific patient. A facility in the hospital network (sieć szpitali) receives a large part of its money in advance, as a lump sum (ryczałt), the size of which depends on the points it reported earlier. How the price itself is set is explained in our text Pricing of services. Here we describe how that price turns into a transfer to the hospital: the lump sum, work above the plan, JGP groups and inspections.

The lump sum: an amount in advance for the whole period

Since 1 October 2017 Poland has had the basic hospital system for securing healthcare services (podstawowy szpitalny system zabezpieczenia świadczeń, PSZ), commonly called the hospital network. A hospital in the network receives a lump sum for its specialties (profile), that is, an amount fixed in advance for the settlement period. The length of the period — a quarter, half a year or a year — is set by the president of the NFZ. The hospital still reports every service, but the valuation of these reports works like a meter that will set the lump sum for the next period, not like an invoice.

The formula presented when the network was launched by the then deputy minister of health combines four elements:¹

1. 01.

   Performance. How many points the hospital reported relative to the basis of its current lump sum — the 98% threshold depends on this.

2. 02.

   Overperformance. Work above the plan counts only in part, on a degressive scale.

3. 03.

   Growth of the NFZ plan. Additional money when the Fund’s financial plan grows.

4. 04.

   Quality. A bonus for, among other things, accreditation, more outpatient services and fewer readmissions.

Outside the lump sum are, among others, hospital emergency departments (SOR), admission rooms, and night and holiday primary care. The same deputy minister, a co-author of the reform, estimates on his blog that about 46% of the value of network hospitals’ services was outside the lump sum: part paid up to the limit in the contract, part without a limit.² This is an estimate by the author of the changes, with no method given, not NFZ data. The same post shows that the regulation on the lump sum was amended as early as 2018; further changes came in, among other years, 2024 and 2026. The 98% threshold itself, however, reads the same in the current consolidated text as in the original 2017 version.³

The 98% threshold: today’s points are tomorrow’s lump sum

A network hospital that in a settlement period reports at least 98% of the points on which its current lump sum was based will keep, in the next period, a lump sum at the full basis, adjusted among other things for changes in tariffs and the quality coefficient. If it reports less, the basis of the next lump sum becomes the number of points actually reported.³ With performance of exactly 98% the lump sum stays in full, because the provision sets the condition “at least”.

Two caveats. The denominator is not the plan in the contract but the number of points from which the current lump sum was calculated. And the threshold itself applies only to hospitals in the network (PSZ) and to setting their lump sum for the next period — the provision does not cover other contracts with the NFZ.

In the hospital network, below the 98% threshold the lump-sum basis falls along with the points reported, and from the threshold upwards it stays in full.

Points reported relative to the basis of the current lump sum	Lump-sum basis for the next period
50%	50% of the current basis
97%	97% of the current basis
at least 98%, e.g. 98% or 99%	100% of the current basis
above 100%	100% of the basis, and the surplus counts only in part

The future lump sum therefore depends on the sum of points reported, not directly on the cost of treatment. Points become a currency, and the 98% threshold a target for the end of the period. The proper way to reach it is to admit more patients. When points are lacking, however, there is a temptation to “make them up” on paper. Where abuse begins is described in our text Visits that never happened.

Overperformance: work above the plan

Services above the contracted limit (nadwykonania, overperformance) are services provided above the plan or the limit in the contract. In the hospital network these are points above the lump sum: when the next lump sum is calculated they count only in part, and they can be financed only from money not used for other services, that is, from so-called underperformance (niedowykonania).¹ Outside the lump sum the NFZ is, as a rule, not obliged to pay for work above the limit, but there are exceptions:

The NFZ published the levels of funding for 2025.⁴ The Fund may pay from the financial plan for a given year until 20 February of the following year at the latest; what it settles later is covered from the current year’s budget.

The longest dispute concerned emergencies. To a facility without an NFZ contract, the Act on publicly funded healthcare services (Article 19(4)) grants only reimbursement of costs for saving a patient. In March 2019 a seven-judge panel of the Supreme Court ruled that a hospital with a contract which saved lives above its limit receives the full rate in the contract, not merely reimbursement of costs. The dispute had lasted about 20 years.⁵

Previously, hospitals often went to court with the Fund over overperformance. In 2009 hospitals claimed PLN 33 million (≈ €7.49 million) from the Wrocław branch of the NFZ, and in 2011 as much as PLN 121 million (≈ €27.5 million). According to statistics from the NFZ headquarters, between about 270 and 450 such court cases were pending nationwide each year at the time.⁶

JGP points: the description of the stay decides the payment

How many points a hospital stay brings is decided by its group in the Diagnosis-Related Groups system (JGP, Jednorodne Grupy Pacjentów).⁷ The group is assigned on the basis of the hospital’s report: diagnoses, procedures performed, sometimes the patient’s age. The value of the group is set by the tariff. Some tariffs are calculated by the Agency for Health Technology Assessment and Tariff System (AOTMiT) and announced in notices,⁸ the rest are set by the payer itself — more on this in our text Pricing of services.

Since payment is made for what is recorded, there is an incentive to describe a stay as more expensive: to add a procedure, choose a more highly priced diagnosis or treat in hospital instead of in an outpatient clinic. Such inflation is called upcoding. We describe the incentive; we do not claim that most hospitals behave this way — we have found no data on the scale of the phenomenon across the whole system.

The evidence is the medical records, to which the patient (only to their own) and the NFZ inspector have access, which is why such cases come to light after an inspection. In the NFZ inspection report for the first quarter of 2026, the Rzeszów branch reviewed the records of 93 patients of a local hospital for whom 96 services had been billed in group H31F (complex procedures on the lower limb and pelvis in patients under 66). According to the inspectors, the entries did not confirm the procedures justifying this group. The penalty — PLN 1,870,003 (≈ €424,000) — was the highest in the country in that quarter.⁹ We also refer to this case in our text Visits that never happened.

Inspection: the only place where billing meets the medical records

Whether a JGP group matches the medical history is checked by an NFZ inspection: it compares the records of selected patients with the report. If a settlement does not hold up, the facility returns the money paid without grounds and may pay a contractual penalty. The scale of inspections was given on 3 July 2026 by the prime minister, citing NFZ data. His statement was quoted by the Polish Press Agency (PAP) in a report published by Rynek Zdrowia:¹¹

According to NFZ data cited by the prime minister, almost every inspection finds irregularities.

	2025	2026, part of the year
Inspections	798	482
Share of inspections with irregularities	97%	99%
Notifications to the prosecutor’s office	27	11
Amount covered by notifications	PLN 53 million	PLN 20 million

The percentage thus shows only that an inspection, once it takes place, almost always finds something. It does not say what share of all settlements departs from what was actually done — we have found no such measurement in public data.

The prime minister did not say what exactly he was counting. His figures are best matched by inspections under Article 61a of the Act on publicly funded healthcare services from the quarterly reports of the NFZ Inspection Department: 779 in 2025 and 468 up to 30 June 2026.¹³¹² This is a match, not a definition: the difference of 19 inspections for 2025 remains unexplained, and the 14 additional inspections in 2026 may result from the prime minister counting up to 3 July. The same reports show that 755 inspections in 2025 (96.9%) and 462 in the first half of 2026 (98.7%) ended with a negative assessment or a positive assessment with irregularities — most likely the source of the 97% and 99% figures (our calculation).

Another measure is the figure of 490 from the Inspection Department’s report for the first quarter of 2026. It covers inspections and verification activities, including those concerning the prescribing of medicines and pharmacies; there were 294 inspections under Article 61a alone in that quarter.¹² The NFZ’s annual plan of coordinated inspections for 2026 provides for at least 186 proceedings, but this is only part of its inspection activity.¹⁴

What can be seen from the outside

In the Internet Patient Account (IKP), a patient can see the services billed in their name and their cost, and has the right of access to their own medical records. How to review your history is shown in the guide in our text Visits that never happened. The rest stays between the hospital and the NFZ:

An inspection reaches this evidence selectively and with a delay — only where the Fund looks. The last item on the list of what only the hospital and the NFZ can see is a gap common to all the mechanisms described on this site: nobody adds up public payments for one person. We write about it in Lack of transparency as a condition for abuse. That is why we call for public total payments from public money for each person, under a permanent identifier, without names — details on the Proposal page.

Notes 14laws, data and statements we relied on

1. Rynek Zdrowia, “Ministerstwo wyjaśnia sposób obliczania ryczałtu — zasady sieci szpitali i próg 98%” (“The ministry explains how the lump sum is calculated — hospital network rules and the 98% threshold”, in Polish), 18.09.2017. ↩ ↩²

2. piotrgryza.pl, “Zasady finansowania szpitali w sieci” (“Rules for financing hospitals in the network”, in Polish) — blog of a former deputy minister of health, co-author of the reform (the author of the changes describing them, not NFZ data). ↩

3. Regulation of the Minister of Health of 22 September 2017 on the method of setting the lump sum of the basic hospital system for securing healthcare services, consolidated text: Dz.U. 2025 item 878 (in Polish), § 3(1)(3)–(4); amended by Dz.U. 2026 item 105. ↩ ↩²

4. NFZ, “NFZ rozlicza nadwykonania w świadczeniach nielimitowanych” (“The NFZ settles overperformance in services without a limit”, in Polish), 20.04.2026. ↩

5. Rzeczpospolita, “Sąd Najwyższy w sprawie zasad płacenia za nadwykonania ratujące życie w stanach nagłych” (“The Supreme Court on the rules of payment for life-saving overperformance in emergencies”, in Polish) (III CZP 80/18), 19.03.2019. ↩

6. Rzeczpospolita, “Niekończące się spory o pieniądze na leczenie pacjentów” (“Never-ending disputes over money for treating patients”, in Polish), 04.05.2012. ↩

7. NFZ, “Jednorodne Grupy Pacjentów — materiały dla świadczeniodawców” (“Diagnosis-Related Groups — materials for providers”, in Polish). ↩

8. AOTMiT, “Taryfikacja świadczeń — obwieszczenia Prezesa AOTMiT” (“Tariff-setting for services — notices of the President of AOTMiT”, BIP, in Polish). ↩

9. Super Nowości, “Blisko 2 mln zł kary dla rzeszowskiego szpitala — największa w kraju” (“Nearly PLN 2 million penalty for a Rzeszów hospital — the largest in the country”, in Polish), 08.07.2026 (NFZ inspections, Q1 2026). ↩

10. Rynek Zdrowia, “26 tys. zł za godzinę, ponad 300 tys. zł za dzień. Tak miała działać spółka neurochirurgów” (“PLN 26,000 an hour, over PLN 300,000 a day. This is how a company of neurosurgeons allegedly operated”, in Polish), 07.07.2026 (PAP citing WP). ↩

11. Rynek Zdrowia, “Balicki: bez zmian personalnych w MZ i NFZ nie będzie reform” (“Balicki: without personnel changes at the Ministry of Health and the NFZ there will be no reforms”, in Polish), 03.07.2026 — PAP report with NFZ data on inspections given by the prime minister. ↩ ↩²

12. NFZ, report on the activities of the Inspection Department for the first quarter of 2026 (in Polish; 490 inspections and verification activities, p. 4; 294 inspections under Article 61a: 15 positive assessments with irregularities and 275 negative, p. 9) and for the second quarter of 2026 (in Polish; 174 inspections under Article 61a: 14 and 158). Totals for the half-year — our calculation. ↩ ↩² ↩³

13. NFZ, reports on the activities of the Inspection Department for the first, second, third and fourth quarter of 2025 (in Polish), chapter on inspections under Article 61a of the Act on publicly funded healthcare services. Inspections: 200 + 215 + 173 + 191 = 779; positive assessments with irregularities: 34 + 28 + 14 + 21 = 97; negative: 155 + 186 + 155 + 162 = 658 (totals — our calculation). ↩ ↩²

14. NFZ, “Plan kontroli Narodowego Funduszu Zdrowia na 2026 r.” (“National Health Fund inspection plan for 2026”, in Polish), 16.03.2026 — minimum number of proceedings in coordinated inspections: 74 (services), 64 (prescribing), 48 (pharmacies). ↩