D6.9 – Report on stakeholders’ views on the effects of payment mechanisms (analysis of in-depth interviews)

How hospitals are paid quietly shapes the care patients receive. When a funding system rewards the wrong things, it can discourage quality, underfund simpler treatments and fail to keep up with new medical technologies. This report listens to the people who work inside such a system every day, hospital managers, public payers and health economists in Poland — to understand how the country’s hospital payment model, based on Diagnosis Related Groups (DRGs), is affecting the healthcare system and what would need to change to make it work better.

The report draws on two rounds of structured consultation: a focus group held in December 2024 with participants from the National Health Fund, the Agency for Health Technology Assessment and Tariffication, hospitals and academia, followed by ten in-depth expert interviews conducted between March and May 2025. Building on an earlier literature review of hospital incentives (Task D6.7), the interview transcripts were analysed through a PESTEL framework, which organises the external forces shaping healthcare financing into political, economic, social, technological, environmental and legal factors. The picture that emerges is that although the DRG system was designed to improve efficiency, in practice it has produced several unintended effects,  outdated tariffs, underfunded conservative treatments and slow adaptation to change — pointing to a clear need to rethink payment mechanisms so they better match the real health needs of the population.

What the deliverable contains:

• A description of the study design, combining a stakeholder focus group with in-depth expert interviews
• A summary of the main problems experts identified in the DRG-based hospital financing system, from outdated tariffs to reporting and billing difficulties
• A PESTEL analysis mapping the political, economic, social, technological, environmental and legal factors that influence financing decisions
• Background on the Polish healthcare system and how DRGs are used to fund hospital services
• Insights into the conditions needed to reform hospital payment mechanisms, focused on cardiology, ophthalmology and neurology