The satellite health account is one of the most important analytical tools used to measure the economic impact of the healthcare sector on the national economy. Its structure makes it possible to isolate those production processes and financial flows that are not fully visible in the traditional system of national accounts, yet play a strategic role in the functioning of the entire state. Unlike classical statistics on health expenditures, the satellite account makes it possible to analyse the activity of healthcare providers in a way similar to the assessment of economic sectors such as industry, construction or trade. This means that the healthcare sector is treated here as a real branch of the economy, which generates value added, incurs costs, employs workers and invests in fixed assets. From an analytical point of view, this is extremely important, as it allows for a precise comparison of the importance of healthcare with other segments of the economy.
In 2021, the importance of these analyses became particularly evident. It was the first full year of the healthcare system’s functioning after the most intense phases of the COVID-19 pandemic. Restrictions introduced in previous years, changes in the structure of services and shifts in the allocation of resources led to significant disruptions in the activity of the medical sector. Data from Statistics Poland (GUS) indicate that despite organisational and economic challenges, the healthcare sector demonstrated significant economic resilience and the ability to grow dynamically, which translated into increased gross output and higher gross value added. The gross value added of providers in 2021 reached PLN 140 billion, which means an increase of PLN 34 billion compared to the previous year. Such a pronounced dynamics shows that the health sector has become one of the main components of economic growth.
One of the key assumptions of the satellite account is the analysis of activity by types of providers defined in the international Health Care Providers (HCP) classifications. This makes it possible to separate the activities of hospitals, ambulatory providers, suppliers of medical products, administrative institutions and other units in the system. Data for 2021 show that two groups of providers – hospitals (HP.1) and ambulatory care providers (HP.3) – accounted for the vast majority of transactions recorded in the health account. This means that the structure of the Polish healthcare system remains strongly dominated by these two segments, both in production and cost terms. However, this dominance is not a negative phenomenon – on the contrary, it reflects the fundamental role of these providers in the delivery of medical services and corresponds to the pattern of population needs.
From the point of view of macroeconomic analysis, the relationship between gross output and intermediate consumption is particularly important, as it determines the level of value added generated. In 2021, the gross output of the health sector amounted to PLN 225.4 billion, which means an increase of 28.1% year on year, while intermediate consumption rose by 22.1%, reaching PLN 85.4 billion. This comparison shows that the dynamics of revenue growth was higher than the dynamics of the costs of materials and outsourced services, which allowed for a clear increase in the generated value added. This is a very positive signal, indicating an improvement in the sector’s efficiency as well as the growing importance of health services in the economy.
The presentation and interpretation of these data are crucial for understanding the role of healthcare as an economic sector that not only fulfils social functions but also acts as an important engine of economic growth. In the following parts of the article, we will analyse in detail the individual components of the satellite account, such as the structure of providers, the sources of value added, cost relations, investment directions and the final use of health goods and services. This will allow for a comprehensive view of the healthcare sector in Poland in 2021 and an assessment of its role in the national economy.
Table 1. Key indicators of production and value added in the healthcare sector in 2021
| Indicator | 2020 | 2021 | Dynamics (2020=100) |
|---|---|---|---|
| Gross output | PLN 175.853 bn | PLN 225.354 bn | 128.1 |
| Intermediate consumption | PLN 69.930 bn | PLN 85.364 bn | 122.1 |
| Gross value added | PLN 105.923 bn | PLN 139.990 bn | 132.2 |
| Employment-related costs | PLN 56.569 bn | PLN 68.926 bn | 121.8 |
| Gross operating surplus | PLN 51.746 bn | PLN 71.431 bn | 138.0 |
Source: authors’ own calculations based on GUS data
The structure of healthcare providers and their contribution to the economy
The structure of providers in the Polish healthcare system has for years been characterised by a high concentration of activity in two basic segments: hospitals and ambulatory healthcare. GUS data for 2021 clearly show that these two groups account for more than three-quarters of the gross output and value added generated by the health sector. Hospitals (HP.1) accounted in 2021 for 39.7% of gross output, while ambulatory healthcare providers (HP.3) accounted for 39.0%, giving a combined share of 78.7% in total health output. A similar dominance is also observed in value added generation, where the ambulatory segment accounted for 44.6% and the hospital segment for 32.0% of all values in this area. This means that the sector’s structure remains exceptionally stable and that the two key provider groups set the tone for the entire health market.
One of the most telling findings of the report is that, despite organisational difficulties resulting from the pandemic, ambulatory healthcare has maintained – and even strengthened – its position in generating value added. Compared to 2020, the share of the ambulatory segment increased from 41.4% to 44.6%, suggesting that a significant share of medical activity returned to specialist and primary care practices after a period of limited operation of inpatient facilities. Ambulatory providers are by nature more flexible, have lower fixed costs and adapt more quickly to changing demand. This enabled them to resume activity more efficiently and respond to the huge backlog of health needs that emerged after the pandemic-related “diagnostic arrears”.
In the case of hospitals, which also maintained a high share in production and value added, the dynamics resulted largely from the need to resume procedures postponed during the pandemic. In 2021, hospitals continued to treat a significant number of post-COVID complications, and in addition had to catch up on months of delays in planned procedures. The high share of hospitals in gross output (nearly 40%) is therefore a natural reflection of their systemic role, but at the same time it shows heavy pressure on public budgets, as hospitals generate the highest employment-related costs and intermediate consumption. According to GUS data, as much as 52.1% of the sector’s intermediate consumption in 2021 was attributable to hospitals, which confirms their high energy and capital intensity of operations.
A characteristic feature of the structural analysis is also the small, almost marginal share of some categories of providers, such as preventive care (HP.6) or inpatient long-term care (HP.2). In 2021, these two groups together accounted for only 1.2% of gross output and 0.7% of value added. This very low share is particularly important from a strategic perspective. It indicates structural underfunding of prevention and the absence of a sufficiently developed long-term care system, which is one of the most important challenges of Polish health policy. The low share of these segments results in further overburdening of hospitals, which perform part of the tasks that systemically should belong to other groups of providers.
It is also worth noting that although the hospital and ambulatory segments dominate in terms of production and value added generation, the cost structure highlights their different operational characteristics. Hospitals account for more than 60% of employment-related costs (PLN 41.9 billion), while the ambulatory segment accounts for just under 20% (19.9%). This means that the high value added generated by ambulatory healthcare is achieved at a relatively lower cost. From the perspective of economic efficiency, this is a clear signal that ambulatory care should be developed more intensively, as it offers a better input–output ratio than hospital care.
Table 2. Providers’ share in the healthcare sector’s gross output in 2021
| Category of provider | Share in gross output | Value (PLN bn) |
|---|---|---|
| HP.1 – Hospitals | 39.7% | 89.3 |
| HP.3 – Ambulatory healthcare | 39.0% | 88.0 |
| HP.4 – Providers of ancillary services | 6.5% | — |
| HP.5 – Retailers and other providers of medical goods | 5.4% | — |
| HP.7 – Health system governance and administration | 5.0% | — |
| HP.2 + HP.6 – Long-term care + preventive care | 1.2% | — |
Source: authors’ own calculations based on GUS data
The analysis of the providers’ structure in 2021 reveals a sector with a strong concentration of activity in two main segments, accompanied by underinvestment in areas crucial for long-term public health, such as prevention and long-term care. In the next section, we will move on to discuss the production and income generation account, which will help explain the mechanisms behind value added growth and the key cost drivers.
The production and income generation account – dynamics, structure and macroeconomic significance
The production and income generation account is a fundamental element of the satellite health account because it allows us to understand the economic processes taking place in the healthcare sector and their impact on the economy. In 2021, an exceptionally strong increase in the gross output of providers was observed, reaching PLN 225.4 billion, which represents growth of 28.1% compared with the previous year. Such dynamic growth was partly the result of a recovery in activity after pandemic restrictions, but also of increased consumption of health services due to accumulated diagnostic and therapeutic needs. In 2021, the health sector operated under conditions of excess demand, which required more intensive use of resources and directly translated into higher output. These mechanisms are clearly visible in the structure of individual provider groups.
The increase in gross output was also accompanied by higher intermediate consumption, which in 2021 amounted to PLN 85.4 billion, rising by 22.1% year on year. Intermediate consumption includes, among others, medical materials, energy, medicines, outsourced services and other operating costs necessary to carry out therapeutic and diagnostic processes. It is worth emphasising that the dynamics of intermediate consumption was lower than the dynamics of gross output, which means an improvement in the relationship between revenues and operating costs. This is a favourable phenomenon and indicates a growing economic efficiency of the health sector, although it should be borne in mind that in 2021 some material costs were still stabilised, as medical sector inflation was not yet fully felt. GUS data show that improved cost efficiency was one of the main drivers of the increase in gross value added in the period under review.
The most important parameter of the production account is gross value added (GVA), which is the difference between gross output and intermediate consumption. In 2021, gross value added reached PLN 139.99 billion, representing an increase of 32.2% compared to 2020. This is one of the highest increases recorded in the health sector in recent years and points to an exceptional intensification of providers’ activities. Value added is a measure of the real contribution of the health sector to the creation of gross domestic product (GDP), and such a significant jump has a direct impact on the national economy. In 2021, the sector’s share in the total value added of the economy was 6.1%, making healthcare one of the largest service sectors in economic terms.
Another key parameter is employment-related costs, which reflect both the remuneration of medical personnel and other employee benefits. In 2021, these costs increased to PLN 68.9 billion, representing growth of 21.8% year on year. This dynamics is significant, yet still lower than the growth in value added, which again points to an improvement in the sector’s overall efficiency. It should be stressed, however, that wage growth in healthcare during the period under review was unavoidable due to rising staffing needs, increased workloads and pay pressure resulting from the outflow of specialists to the private sector and abroad. These data show that the health sector is in a phase of active cost transformation, where pressure on labour cost growth is one of the main structural challenges.
The final element of the production account is the gross operating surplus, which in 2021 reached PLN 71.4 billion, an increase of 38% compared to 2020. The operating surplus is an indicator of sector profitability, and its exceptionally high dynamics in 2021 indicate stabilisation of providers’ financial liquidity after the difficult period of the pandemic. A high surplus means that the sector had more room to invest in infrastructure development, technological purchases and modernisation of facilities. It is also a sign that the increase in output was not entirely “eaten up” by rising costs, which is a positive piece of information from the perspective of public finances.
Table 3. Production and income generation account in the health sector (2020–2021)
Authors’ own calculations based on GUS data
| Indicator | 2020 | 2021 | Dynamics (2020=100) |
|---|---|---|---|
| Gross output | PLN 175 853.0 mn | PLN 225 354.1 mn | 128.1 |
| Intermediate consumption | PLN 69 929.9 mn | PLN 85 364.4 mn | 122.1 |
| Gross value added | PLN 105 923.0 mn | PLN 139 989.7 mn | 132.2 |
| Employment-related costs | PLN 56 569.0 mn | PLN 68 925.9 mn | 121.8 |
| Gross operating surplus | PLN 51 746.2 mn | PLN 71 430.8 mn | 138.0 |
Source: authors’ own calculations based on GUS data
Macroeconomic significance of production data
Data on gross output and value added make it possible to assess the role of healthcare as an economic sector. In 2021, the sector accounted for 4.2% of the total gross output of the economy and 6.1% of gross value added in Poland. This is a level comparable with the share of sectors such as education, construction or transport. The increase in the share of healthcare in GDP in recent years reflects the growing importance of health services in a modern economy. This results not only from demographic factors, such as population ageing, but also from increased health awareness, lifestyle changes and the development of new medical technologies.
A particularly interesting macroeconomic aspect is the fact that the health sector is characterised by high demand stability. Medical services are a good with relatively low elasticity, which makes this sector a kind of “safe haven” even in times of crisis. In 2021, despite economic uncertainty and high inflation in the general economy, demand for health services continued to grow. This shows that investments in health can form a stable component of national strategies both in economic and social terms.
The year 2021 brought an exceptional expansion of the health sector’s economic activity. The increase in gross output, the rise in value added and the high operating surplus show that the system not only survived the difficult period of the pandemic, but also significantly expanded its production capacity. In the next section, we will move on to an analysis of the supply and use account, which will help us understand where the goods and services produced are ultimately used.
The supply and use account – structure, dynamics and directions of flows
The supply and use account in the satellite system provides information on how the goods and services produced in the health sector are distributed among different groups of users. In 2021, the gross output of health goods and services amounted to PLN 245.5 billion, representing an increase of 28.5% compared to the previous year. This is one of the highest growth rates recorded in the last decade and clearly points to the recovery and development of health services after two years of pandemic-related restrictions. Production includes not only the activity of medical providers, but also the output of suppliers of medical goods, equipment and other entities involved in the provision of health services. As a result, a complete picture of the sector is formed, covering all key elements of the health value chain.
It is worth noting that the overwhelming majority of gross output is generated by healthcare providers, whose production amounted to PLN 220.34 billion, accounting for 89.7% of the total supply of health goods and services. This means that the supply in the health sector remains concentrated on services rather than on the production of material goods. This reflects the specific nature of healthcare, where the dominant element of the provision process is the work and expertise of professionals, while the share of material medical goods remains relatively low. Output from the remaining segments – such as pharmaceuticals, medical equipment, retail or ancillary services – complements the system but does not play the leading role.
Total consumption in 2021 reached PLN 171.45 billion, rising by 11.7% year on year, which indicates increased use of medical services by different institutional groups. As much as 72.4% of this consumption was attributable to government and local government institutions, which act as the main payers for health services in Poland. The remaining share of consumption was financed by households and non-profit institutions serving households. This structure is characteristic of countries where public funding dominates, and where central and local budgets play a key role.
Household consumption amounted to PLN 44.99 billion, an increase of 11.1% year on year. These data suggest that Poles are spending more and more money on private treatment, diagnostics or the purchase of medical goods. This results from the growing availability of private services, pressure to shorten waiting times and rising disposable incomes. At the same time, this is a warning signal – an increasing household share in health financing may indicate growing inequalities in access to public services, especially in the context of an ageing population.
In 2021, a positive balance of foreign trade in health goods and services was also recorded, amounting to PLN 0.1 billion. Exports reached PLN 1.14 billion, while imports amounted to PLN 1.05 billion, which indicates a relatively balanced trade. It should be stressed, however, that the structure of foreign trade in healthcare is specific – exports consist mainly of medical services (e.g. services provided to foreign patients), while imports are primarily high-specialist medical technologies. A positive balance nonetheless indicates the growing importance of Poland as a provider of high-quality health services – often cheaper than in Western Europe, which supports so-called medical tourism.
Table 4. Supply and use of health goods and services in 2020 and 2021
| Indicator | 2020 | 2021 | Dynamics (2020=100) |
|---|---|---|---|
| Gross output | PLN 190 995.7 mn | PLN 245 457.3 mn | 128.5 |
| Providers’ output | PLN 171 620.9 mn | PLN 220 342.1 mn | 128.4 |
| Imports | PLN 889.6 mn | PLN 1 051.1 mn | 118.2 |
| Exports | PLN 928.1 mn | PLN 1 140.9 mn | 122.9 |
| Total consumption | PLN 153 487.7 mn | PLN 171 449.6 mn | 111.7 |
| Household consumption | PLN 40 494.7 mn | PLN 44 990.2 mn | 111.1 |
| Government and local government consumption | PLN 110 770.3 mn | PLN 124 196.7 mn | 112.1 |
Source: authors’ own calculations based on GUS data
Significance of the supply and use structure for health policy
The structure of supply and use makes it possible to assess whether the healthcare system is balanced in terms of financing and accessibility. The dominance of public funding indicates that the Polish model remains strongly centralised and based on state obligations. This is beneficial from the perspective of equal access, but it creates substantial pressure on the budgets of the National Health Fund (NFZ) and local governments. Meanwhile, the growth in individual consumption points to the expansion of the private market, which may lead to greater segmentation of the system – those with higher incomes access services faster and more frequently, while lower-income groups remain dependent on the underperforming public part.
From an economic point of view, the relationship between production and consumption is also important. In 2021, output grew much faster than consumption, suggesting a restoration of system capacity after the earlier reduction in the supply of services during the pandemic years. In the coming years, consumption can be expected to gradually converge towards the level of output, particularly in areas where there are large diagnostic backlogs – such as oncology, cardiology or orthopaedics.
The 2021 supply and use account portrays a health sector in a phase of strong recovery. Rising production, stable consumption and a positive foreign trade balance point to the growing role of Polish healthcare in the economy and its potential for further development. In the next section, we will analyse investment outlays, which are one of the key drivers of long-term system modernisation.
Investment outlays – a key element in modernising the health sector
Investment outlays are one of the most important factors enabling the development and modernisation of the healthcare system. It has long been known that the effectiveness of treatment and the quality of procedures depend not only on the work of medical personnel, but also on the availability of modern infrastructure and equipment. GUS data show that in 2021 investment outlays of the main providers of health goods and services (groups HP.1–HP.5) amounted to PLN 8.7 billion, which represents a 1.7% decrease compared to the previous year. This is a result that should be interpreted with caution, as the decline did not stem from a lack of investment needs, but rather from the strained budgetary stability of many units and uncertainty about the post-pandemic economic outlook. At the same time, the structure of expenditures shows that investments in modern equipment remained a priority.
The largest part of investment outlays was directed to machinery, technical equipment and tools, which accounted for 53.7% of total investment. This means that more than half of all investments were allocated to the technological development of facilities – the purchase of diagnostic equipment, modernisation of operating theatres and investment in IT systems. In the context of global trends in medicine, this is the right direction, as modern healthcare relies on high-resolution diagnostics, robotics, medical informatics and telemedicine. These investments shorten treatment times, improve patient safety and increase procedural precision.
The second important category of investment was the modernisation of hospital buildings and infrastructure. Although GUS data on the share of construction investments are not explicitly detailed in the summary publication, data on investment directions in the economy make it possible to reconstruct the outlay structure. Expenditure by all investors in the economy on the construction, purchase or improvement of facilities intended for healthcare amounted to PLN 9.3 billion, which also represents a 1.7% decrease compared to the previous year. This decline suggests that some local governments and hospitals scaled back large construction investments, focusing instead on faster and more essential equipment purchases. In the longer term, however, this may deepen the problem of obsolete infrastructure.
It is also worth emphasising that the structure of investments in the Polish health sector has for years been strongly linked to the availability of EU funds. In 2021, the 2014–2020 financial perspective was coming to an end, while many investments launched before the pandemic entered their final phase. In practice, this meant that although projects started in earlier years were continued, the launch of new large capital initiatives was limited. This is one of the reasons why the decline in investment outlays should be interpreted as an effect of a temporary “slowdown in the investment cycle” rather than a systemic regression. The subsequent EU perspective from 2022 again increased investment opportunities, especially in digitalisation and hospital infrastructure.
The investor structure is also significant. The largest investment outlays are incurred by hospitals – both public and private – which are the most capital-intensive units in the system. Hospitals house most high-specialist equipment, perform the most advanced procedures and face the strongest modernisation pressures. The next group consists of ambulatory providers, but their share in investments is much smaller, due to their simpler organisational structure and smaller number of procedures requiring advanced equipment. In the case of retailers and laboratories, their share in investment was negligible.
Table 5. Investment outlays in healthcare (HP.1–HP.5) in 2020–2021
| Category of outlays | 2020 | 2021 | Change y/y |
|---|---|---|---|
| Total investment outlays | PLN 8.85 bn | PLN 8.70 bn | –1.7% |
| Machinery, equipment and tools | (approx. PLN 4.8 bn) | (approx. PLN 4.67 bn) | – |
| Buildings, structures and infrastructure | (approx. PLN 3.2 bn) | (approx. PLN 3.1 bn) | – |
| Other investments | (approx. PLN 0.8 bn) | (approx. PLN 0.93 bn) | + |
Source: authors’ own calculations based on GUS data
(Note: some values in brackets have been estimated based on GUS percentage structures – detailed figures were not provided directly in the statistical summary.)
The importance of investment for system quality and efficiency
Investment in healthcare is a key pillar of the system’s long-term stability and development. The increase in output and value added described in the previous sections would not have been possible without gradually implemented modernisation of infrastructure and equipment. These investments increase system capacity, shorten diagnostic times, improve the efficiency of medical teams and enable the performance of procedures that were previously unavailable in the country. At the same time, they enhance patient safety – modern equipment reduces the risk of errors and better-designed buildings improve clinical workflow.
On the other hand, too low a level of investment may lead to a “technological health debt”, manifested in the ageing of equipment, longer repair times, increased failure rates and the inability to perform new medical procedures. In Poland in 2021, many diagnostic devices – such as CT scanners or X-ray machines – had significantly exceeded the useful life recommended by manufacturers. These data do not come directly from the satellite account, but from regional reports and Supreme Audit Office (NIK) publications. In the long run, maintaining investment outlays at an adequately high level will therefore be essential for the modernisation of the entire system.
It should also be noted that investment plays not only a medical but also an economic role. The healthcare sector is a major consumer of technological products, construction services and telecommunication infrastructure. This means that investment in health stimulates activity in many other sectors of the economy, further increasing its macroeconomic significance.
The year 2021 brought relative investment stabilisation, albeit at a slightly lower level than in the previous year. Equipment investments were crucial, while infrastructure investments slowed somewhat. The next part of the article will present an interpretation of the data in the context of long-term trends, allowing us to assess whether the Polish health system is moving towards improved efficiency and quality.
