Abstract

Poland’s public healthcare system faces pressures related to access, regional disparities, and resource allocation. This conceptual study develops the NFZ Strategic Governance Framework (NFZ-SGF), linking population need, allocation, purchasing, delivery, performance, diagnostic accountability, and subsequent decisions. A purposive synthesis of institutional and research sources is supplemented by a documented search of official 2024 data. An original 16-branch descriptive extraction pairs actual branch-executed health-service costs with insured persons, resident population, and counts of hospital-network (PSZ) services from NFZ reports. Branch expenditure totals PLN 132.26 billion, excluding PLN 48.09 billion executed centrally. Expenditure divided by year-end insured persons ranges from PLN 3,531 to PLN 4,224 (pooled ratio PLN 3,866); PSZ reported services per 1,000 insured range from 1,257 to 2,310. Across the 16 branches the two normalized series correlate at r = 0.583, an ecological association with no causal interpretation. These are administrative ratios, not need-adjusted funding estimates. Diagnostic accountability maps an adverse signal to a plausible mechanism and an actor able to correct it; investigative accountability assesses a possible breach. A contemporary source-screening audit identifies what was included and excluded while acknowledging that the earlier purposive search cannot be reconstructed. Three propositions specify prospective tests. NFZ-SGF remains unvalidated; age, morbidity, geography, and workforce cannot be jointly calibrated with the available regional series.

This work is licensed under a Creative Commons Attribution 4.0 License.