Why Hospices in Poland Are Turning Away Patients: A Crisis of Delayed Payments and Staff Shortages

Hospices in Poland are halting admissions even when beds stand empty — not because of official caps, which formally don’t exist, but because months-long payment delays from the National Health Fund collide with a chronic shortage of doctors and nurses.

In short

• There are no formal limits on hospice admissions in Poland — facilities restrict themselves because of payment delays from the fund.
• Payment for services above the contract limit runs in quarterly cycles: a March service gets paid only in August.
• A contract with the fund covers no more than 70% of a hospice’s actual expenses — the rest the facility has to raise itself.
• Poland has a confirmed shortage of 150,000 nurses, and by 2030, 482 hospitals risk closure due to lack of staff.
• The country already employs 2,855 Ukrainian doctors — 57% of all foreign doctors — but recognition of their diplomas remains difficult.

Why Hospices Turn Away Patients Even When Beds Are Free

There are no formal limits on palliative and hospice care in Poland — this was confirmed by Sebastian Goncerz, head of the agreement of resident doctors in Poland. The real reason for refusals lies elsewhere: facilities restrict admissions themselves because of payment delays from the National Health Fund, which pays inconsistently.

According to a physician from the Mazovia region, a hospice used to accept everyone who applied — as many as came, as many were admitted. At a hospice in the town of Łuków, in Lublin Voivodeship, coordinators say plainly that new patient admissions are limited because payment from the fund sometimes takes months to arrive. Some facilities in this situation simply cannot afford to take on a new patient, even with an empty bed available.

At a hospice in the town of Łuków, in Lublin Voivodeship, coordinators say plainly that new patient admissions are limited because payment from the fund sometimes takes months to arrive.

How the National Health Fund’s Payment System Works

The National Health Fund settles payments for services exceeding the contract limit in three-month cycles: a facility is paid not for the current month, but for the entire quarter at once, and only after that quarter ends. An order that took effect on July 30 allowed settlement of payments for services provided from January through March. In practice, this means a hospice that treated patients in March received the money only in August — a five-month gap between service and payment.

a hospice that treated patients in March received the money only in August — a five-month gap between service and payment

According to the fund’s official position, payment is made in full, including services above the contract limit, but it is precisely these settlements that routinely run late. The reason traces back to the decision to abolish the limits in April 2024: facilities sharply increased the number of patients they admitted, while the fund never conducted a prior analysis of whether the system could handle that load. The result is chronic payment delays, which have pushed some hospices to take out loans to cover ongoing operations while they wait for settlement of services already rendered.

How Many Hospices Operate in Poland and How Palliative Care Spending Has Grown

Poland has 224 inpatient palliative care facilities. Most of them are non-governmental hospices, and they have to cover part of their costs themselves: a contract with the National Health Fund covers no more than 70% of a facility’s actual expenses, leaving the rest for the facility to raise on its own.

At the same time, the fund’s budget for palliative and hospice care has multiplied over five years. In 2020, spending exceeded 830 million zloty; by 2023, it had already reached 1.6 billion; and for 2025, planned spending stands at more than 2 billion zloty.

The sharp rise in system load is linked to the abolition of limits in April 2024: after that, hospices began admitting significantly more patients. But according to the fund’s spokesperson, no one conducted a prior analysis of whether the system could withstand that load — and that is exactly what led to the chronic payment delays described above.

Why Poland Doesn’t Have Enough Doctors and Nurses for Hospices

A shortage of doctors and nurses is one of the main factors blocking the creation of new hospice facilities in Poland. In 2020, palliative medicine was added to the list of priority specializations, in the hope of attracting more doctors to the field, but the decision did not raise interest among specialists.

The Supreme Audit Office of Poland found that the Ministry of Health had access to National Health Fund data on patients, service providers, and staff, yet never analyzed that data from the standpoint of workforce need — and never determined exactly how many doctors and nurses the sector as a whole is missing.

The scale of the problem is visible in individual figures. Poland has an officially confirmed shortage of 150,000 nurses. The average age of a working Polish nurse is between 53 and 55, meaning the bulk of staff is approaching retirement age without adequate replacement. At this pace, by 2030, 482 hospitals will be at risk of closing due to staff shortages.

Facilities could technically fill vacancies with medical staff from abroad, but professional unions and associations often resist bringing in outside specialists: according to analysts’ observations, some of these organizations are reluctant to ease conditions for foreign medical workers.

The Role of Ukrainian Doctors and Nurses in Poland

The register of the Supreme Medical Chamber of Poland lists 2,855 Ukrainian doctors — 57% of all foreign doctors in the country. Around 1,000 more Ukrainian nurses hold a Polish license to practice. The staff hospices are missing effectively already exists — these are specialists from Kharkiv, Dnipro, Kyiv, Lviv, some of whom have instead chosen to move to Britain or Germany.

Obtaining a license is extremely difficult for Ukrainian doctors even at the highest level of competence and experience — the same applies to other positions needed by Polish hospitals and hospices. Among the roughly 2 million Ukrainians living in Poland, thousands, possibly tens of thousands, hold medical degrees. Some of them are not working in their field or spend years going through the bureaucratic procedure of having their diploma recognized, while part of the Polish medical associations block this path to recognition.

Obtaining a license is extremely difficult for Ukrainian doctors even at the highest level of competence and experience

The consequence is twofold: hands are missing, and those already working in the field are forced to take overtime shifts and claim extra pay for them — creating additional financial costs for facilities on top of the staff shortage itself. The proposed solution is to simplify the procedure for recognizing foreign medical diplomas and to draw on doctors and nurses who are already in Poland, rather than searching for staff abroad.

Frequently asked questions

Can I, as a patient, do anything to speed up getting a hospice spot if I’m turned away for the facility’s financial reasons?

The material doesn’t describe any appeal or expedite mechanism for an individual patient — admission decisions depend on the facility’s financial state, not the patient’s condition. This is a systemic payment problem rather than a procedure an individual can work around by making a request.

Are hospices already closing because of financial difficulties, or is this still just a future risk?

The situation involves chronic payment delays and loans facilities take out to stay afloat until settlement — that’s a sign of financial strain, not mass hospice closures happening right now. Separately, 482 hospitals are named as being at risk of closure due to staff shortages by 2030 — a different cause and a different type of facility.

Would simplifying recognition of foreign doctors’ diplomas solve the hospice problem in the near term?

Simplifying diploma recognition is proposed as a solution, but it addresses the workforce shortage overall, not directly the payment delays that force hospices to limit admissions. Even with more doctors and nurses, a facility would still have to wait for the fund’s quarterly payment cycle.

Why are Ukrainians such a large share of foreign doctors in Poland?

Ukrainian doctors make up 57% of all foreign doctors in Poland — 2,855 people — with about 1,000 more Ukrainian nurses holding a license to practice. This is explained by geographic proximity and the scale of Ukrainian migration to Poland, though some specialists with medical training have instead chosen to move to Britain or Germany.

Can a refusal by a medical association to recognize a Ukrainian diploma be appealed?

The diploma recognition process is influenced by Polish medical associations, which, according to observations, sometimes block this path, but no appeal mechanism for such a refusal is described. What is known is that the diploma confirmation procedure can take years even for highly qualified specialists.