Abstract:

The Polish healthcare system continues to generate structural dissatisfaction despite growing public expenditures and repeated reform efforts. Long waiting times, inefficiencies in coordination, and an increasing shift toward private out-of-pocket financing indicate persistent systemic weaknesses. This article critically examines the feasibility of introducing Medical Savings Accounts (MSAs) — previously proposed in Poland in 1992 by Zygmunt Hortmanowicz and his team — as an alternative or complementary financing mechanism. Using institutional analysis, transaction cost theory, and contemporary pharmacoeconomic data, the study evaluates whether a capital-based individual financing model can withstand the cost-intensity of modern medicine and the demographic realities of population aging. The analysis demonstrates that while MSAs may function as a supplementary mechanism for outpatient and preventive services, they are structurally incapable of replacing the solidarity-based public system in financing catastrophic and chronic conditions. A hybrid model preserving a centralized solidarity pillar while incorporating limited individual savings mechanisms is proposed as a more rational reform direction.