Judgment of the Constitutional Tribunal on the liability of local governments for losses of independent public health care institutions (SPZOZ)

On 20 November 2019, a hearing was held before the Constitutional Tribunal in the case of the motion of the Sejmik of the Mazowieckie Voivodeship concerning the financial liability of local government units (in this case the local government of the Mazowieckie Voivodeship as the constituent entity) for the net loss of independent public health care institutions (ref. K 4/17).

The following took part in the hearing as an audience: legal adviser Anna Piotrowska-Musioł and trainee attorney Paulina Kozłowska from the Department of Medical Law and Services for Medicinal Entities, who in everyday practice represent medical entities in proceedings concerning recovery of debts from the National Health Fund.  

The essence of the examined case was to determine who – the State or local government units – is obliged to finance health care services. The Court found that the obligation, challenged by the applicant, to cover the net loss of independent public health care institutions by the constituting body means de facto the obligation of that body to finance the services provided by them. 

In the context of the above, the Court referred to the content of Article 68(2) of the Constitution, which is the source of responsibility of the public authority for equal access of citizens to health care financed from public funds. 

After the hearing, the Constitutional Tribunal issued a judgment in which it found that the provision imposing on constituting entities the obligation to cover the net losses of independent public health care institutions is inconsistent with the Constitution, in particular with the provision guaranteeing equal access of citizens to health care services.

When analysing the ruling, it should be noted that the Tribunal verified the functioning of the health care system and made a negative assessment of it, also with regard to the need for medical entities to seek legal redress for the payment for the so-called above-limit services.

The payment for services provided in excess of the limits resulting from the concluded agreements on the provision of health care services (and currently, in the case of hospitals included in the network of hospitals – above a fixed lump sum) was and still is the subject of numerous disputes. 

Contrary to the obligation existing on the part of the National Health Fund to finance the services provided in the cases of sudden life and health threats, confirmed by the Supreme Court’s case-law, the entity obliged to finance services gradually refuses to pay the hospitals. 

As a result, medical entities conduct long-standing court disputes in order to obtain payment for services rendered. For many years, the Law Firm has been representing public and private medical institutions in proceedings for payment for the so-called above-limit services, and now also for payment for services rendered in an emergency over the value of the lump sum granted in contracts concluded with the National Health Fund. 

Therefore, the ruling handed down in the Constitutional Tribunal is another confirmation that the responsibility for financing health services lies with the National Health Fund, and the arguments presented in its grounds will certainly strengthen the positions presented by the Law Firm in payment trials conducted on behalf of medical entities throughout Poland.