How can Poland implement a healthcare system based on public value? We describe a new model integrating VBHC, digitalisation, and organisational reform – the conceptual foundations of the Polish Health System (PSZ)®, a public-value-based model that combines the reorganisation of care with digitalisation – and outline a phased implementation strategy based on pilots, stakeholder engagement, and digital inclusion.
Introduction – the urgent need for reform of Polish healthcare
Poland's healthcare system, despite significant progress since the 1990s and in recent years, still faces structural challenges: long waiting times for diagnostics and specialist consultations, regional inequalities, shortages of medical staff – particularly in less populated areas – and a persistent focus on billing the volume of services rather than population health value.
Despite rising public spending – which reached 6.5% of GDP in 2024 – Poland remains below the EU average of 9.9%, and outcomes in areas such as avoidable mortality and patient satisfaction remain areas for improvement.
These challenges are compounded by a rigid, hospital-centric model of care delivery. Poland, like many Central and Eastern European countries, faces the need to align with a key global trend: the shift from hospital-dominated systems toward integrated, coordinated, patient-centred care in settings closer to home, driven by demography, technology, and the imperative of financial sustainability.
Part one – the European imperative: deinstitutionalisation as a strategic vector
Deinstitutionalisation of healthcare represents a fundamental reorientation: the shift from reactive, episodic treatment in hospitals to proactive, continuous, and coordinated care closer to home. It is characterised by:
- Shifting the centre of gravity from hospitals to ambulatory, community, and home care.
- Strengthening the role of Primary Care (POZ) as a pillar and care coordinator.
- Integration of health and social services.
- Use of digital technologies to support coordination and efficiency.
- Activation of patients and carers in the therapeutic process.
This trend is most advanced in the Nordic countries and the United Kingdom, but it is a strategic priority across the European Union.
Denmark, for example, reduced the number of hospital beds by more than 50% over two decades while simultaneously investing in strong municipal health centres. The long-term plan of the British National Health Service emphasises Integrated Care Systems and virtual care. The Catalonia region in Spain was a pioneer of integrated health and social organisations.
For Poland, engagement with this trend is essential to building a resilient, future-ready system. The PSZ model proposes concrete frameworks for such a transformation, adapted to the Polish context.
Part two – conceptual foundations of the PSZ model: key components
The PSZ model is built on four interdependent pillars, each designed to address systemic weaknesses and promote a deinstitutionalised, value-based ecosystem.
- 1. Value-based financing. The model proposes an evolutionary transition from payment for individual procedures to financing focused on achieving measurable health outcomes and patient experience. The vision assumes the creation of integrated medical products and care packages linked to clinical results, patient satisfaction, and cost-effectiveness.
- 2. Organisational integration – Integrated Health Organization (ZOZ). The operational heart of the model is the ZOZ concept – a cluster integrating care at three levels:
- Ambulatory and coordinated care: Strengthened POZ serving as the main coordinator, integrated with diagnostics and specialist clinics within integrated one-day diagnostics (ZOD1D), aimed at preventing hospitalisations.
- Acute and emergency care: An integrated structure at the regional level, ensuring effective routing of patients to appropriate treatment settings in emergency conditions, reducing overload of hospital emergency departments.
- Planned hospital treatment: Reserved for complex, scheduled procedures, with a smooth transition of the patient back to ambulatory care.
- 3. Digital inclusion and the NID platform. Transformation requires advanced connectivity and intelligent steering. The model assumes the establishment of the National Longevity Institute (NID), playing the role of a value regulator, innovation hub, and operator of an intelligent digital platform. Its tasks would include, among others, supporting care coordination through AI algorithms, analysis of population data, verification of achieved outcomes, and accreditation of entities in the system.
- 4. Independent strategic governance. To ensure the durability of the reform and protect it from short-term political cycles, the PSZ model proposes the establishment of an independent, apolitical expert body – the Council of Guardians of Public Value and Health. Its role would be to protect the system's long-term mission, oversee the implementation of innovations (including the ethical use of AI), and ensure that clinical decisions remain in the hands of medical staff.
Part three – implementation proposal: a phased, pilot-based approach
The PSZ model is designed for gradual, evidence-based implementation, minimising systemic risk:
Selection of one or two regions (e.g. Małopolska Voivodeship) for pilot implementation of key elements of the model. Key activities would include staff training, deployment of basic digital tools, testing of ZOD1D, and measurement of effects (including patient satisfaction, reduction of unnecessary hospitalisations, time to diagnosis).
Extension of pilots to additional regions, launch of advanced functionalities of the NID digital platform, adjustment and standardisation of payment models based on data from the first phase, development of integrated care infrastructure.
Completion of the national scaling process, full deployment of the advanced NID platform and value-based financing models, establishment of a national network of accredited ZOZ entities.
Sharing experience, best practices, and technological solutions with EU partners, particularly with Central and Eastern European countries facing similar challenges.
Part four – alignment with European health priorities
The PSZ model directly supports key EU strategic initiatives:
- European Health Data Space (EHDS): The NID platform would serve as a national node for secure data exchange and analysis, essential for coordinating decentralised care.
- Artificial Intelligence Act: Provides a framework for the ethical and safe use of AI algorithms in healthcare, which is the foundation of the NID platform's operation.
- Europe's Beating Cancer Plan: Integrated, coordinated oncology pathways in the ZOZ model enable earlier detection and better continuity of care.
- European Green Deal: Reduction of the need for patient travel, optimisation of energy and resource use in hospitals through shifting care closer to home.
Part five – challenges, risks, and mitigation strategies
| Challenges | Primary risk | Proposed mitigation strategy |
|---|---|---|
| Institutional and cultural resistance | Reversal of the reform, opposition from hospital communities | Early, broad engagement of all stakeholders, transparent modelling of benefits, retraining programmes |
| Digital and infrastructure gaps | Digital exclusion, unequal access | Gradual IT rollout, hybrid service models (digital and in-person), infrastructure investment |
| Workforce shortages | Lack of staff for new roles (coordinators, POZ) | New career paths and incentives, expanded nursing competencies, targeted training programmes |
| Funding constraints | Insufficient capital for initial investments | Blended financing (EU funds, PPP partnerships, reallocation of savings from reducing unnecessary hospitalisations) |
| AI and data-related risks | Loss of trust, algorithmic errors, data breaches | Strong ethical and legal frameworks, oversight by the Council of Guardians, "human in the loop", highest cybersecurity standards. |
Part six – vision and conclusions: a historic opportunity for Poland
The ultimate change is a change of mindset: the challenges of the health system will become optimisation problems, solved by interdisciplinary teams, with progress visible on a public dashboard.
The National Longevity Institute (NID) is more than a platform – it is a national mission and brand, fulfilling a dual function:
- Health system disruptor: the engine of PSZ transformation, implementing deinstitutionalisation and value-based care.
- Export product and ecosystem: the foundation of a new, high-margin branch of the economy based on exporting knowledge and technology from the longevity and BioMedTech sectors.
Conclusions: not a reform, but a historic opportunity
The PSZ model is a project to build a new branch of the Polish economy. It enables Poland to:
- Escape the middle-income trap by entering the early stage of the trillion-dollar longevity market.
- Stop brain drain by offering specialists work in the most advanced health ecosystem, and patients – the removal of systemic absurdities.
- Change the narrative from "NFZ on the brink of bankruptcy" to "Poland – exporter of breakthrough systemic solutions".
- Fix its own health system while building a global innovation hub in the BioMedTech and Longevity sectors.
PSZ transforms the challenge of health system reform into a historic economic and innovation opportunity, inviting international dialogue on the future of healthcare. This evidence-based, long-term discussion is urgently needed in Poland.
Article by prof. dr hab. n. med. Mieczysław Pasowicz, MD, PhD, FACC, FESC, from the Institute of Innovative Medicine.
Acknowledgements – the author thanks the Health4You.eu team, the Institute of Innovative Medicine, and substantive partners for their contribution to the development of the concept.
Conflict of interest statement – prof. dr hab. n. med. Mieczysław Pasowicz is the creator of the conceptual PSZ model and founder of the Institute of Innovative Medicine. All rights to implementation details, algorithms, and operational models constitute trade secrets of the Institute and are legally protected. No other conflicts of interest were declared.
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This article publicly presents the conceptual foundations of the reform model. Implementation details, algorithms, process models, and technological solutions constitute the intellectual property of the Institute of Innovative Medicine and are protected as trade secrets.