Romania

Background

In 1992 Romania began to slowly decentralise public administration, including healthcare. In 1994, the Health Ministry initiated a pilot programme which terminated GPs’ status as hospital employees and began holding contracts with the District Health Directory as well as introducing patient choice for GP services. This pilot continued until 1997 when it was discontinued by the new Liberal and Christian Democrat government, who shifted towards a social health insurance system in 1998.

The set of reforms starting in 1998 were the first to change the financial base of the health system in the post-transition period. General taxation was replaced with mandatory insurance premiums paid by employees (6.5%) and the employer (7.0%), and the National Health Insurance Fund became a self-governing body. Moreover, the insurance law contributed to the development of the private sector in health, with GPs previously employed by the state becoming independent practitioners.

Recent years

Subsequently, Romania has faced issues such as an underfunded National Health Insurance Fund, migration of medical staff and high out-of-pocket payments. In 2005, it was estimated that 5 million people were paying insurance contributions while 22 million were entitled to benefits. Reforms in 2006 restricted exemptions from contribution, especially for pensioners, but a rebalancing of the system is not yet visible. On the migration of medical practitioners, no reforms have materialised so far.

Current situation

Currently, health workers receive their salaries from the National Health Fund, thus restricting them from switching to better-paying private contractors within the country. Furthermore, out-of-pocket payments to health care providers are estimated to comprise a third of Romania’s total healthcare funding, making people extremely vulnerable to sudden increases in healthcare costs. It still remains to be seen how Romania will deal with out-of-pocket payments, whether by integrating them into the formal pricing system or replacing them with increased public spending.

Overall, Romania seems to have lacked a clear vision for the future. The reforms it has set in motion often do not materialise due to frequent reshuffling within the Ministry of Health. However, the current government, which is run through a coalition of the Democratic Liberal Party (DLP) and the alliance of the Social Democratic Party (SDP) and the Conservative Party (CP), has doubled the budget allocated towards health in the last three years, indicating that healthcare has become a greater priority for the government, and might elicit more far-reaching, consistent reforms.

Romania statistics

WHO Health Statistics (current data)                                       * Data for 2005

¹ Probability of dying between 15 to 60 years per 1000 population

²  Per 1,000 live births

³ In Years

⁴ In Years

⁵ Purchasing Power Parity int. dollars

⁶ Purchasing Power Parity int. dollars

⁷ Percentage

⁸ Per woman