Romanian healthcare market overview

The healthcare sector has always been a continuous challenge for many countries in Europe and it still is a complex and sensitive topic to be addressed in any part of the world. During the past two decades, Romania has gone through a period of rapid and major changes in every sector, including health.

The local healthcare industry encountered the same difficulties as in all the Central and Eastern Europe (CEE) healthcare systems: a low level of government financing, inadequate and obsolete equipment and facilities, management deficiencies, informal payments all the aforementioned resulting in an overall increasing dissatisfaction of population. At present, Romania’s healthcare system is still dominated by the public healthcare system, being funded by a combination of employer and employee contributions to the National Health Insurance Fund (NHIF) and of direct allocations from the state budget.

Romania has a mandatory insurance-based financing model for healthcare, involving contributions from employers (5. 2% of the gross wage) and employees (5. 5% of the gross wage). The health insurance system is administrated and regulated by NHIF, a central quasi-autonomous body. Since 1998, when the country adopted the mandatory social health insurance system, the roles of the main participants in the health system have changed, the relationships between different organizations have become more complex and the number of stakeholders has increased.

The system is organized at two main levels: national/central level and county level. The Ministry of Public Health responsibilities consist of developing national health policy, regulating the health sector, setting organizational and functional standards, and improving public health. The representative bodies of the Ministry of Public Health at the district level are the 42 district public health authorities (DPHAs). Also at district level, 42 District Health Insurance Funds (DHIFs) are responsible for contracting services from public and private healthcare providers according to the rules set by the central units.

Two national insurance funds have been established in 2002, one belonging to the Ministry of Transport (CAST) and the other to the Defence System, Public Order, National Security and Justice (OPSNAJ Authority). Since 2002, the social insurance contributions have been collected at the national level by a special body under the Ministry of Finance (the Fiscal Administration National Agency), and DHIFs have raised contributions only from insured persons paying the whole contribution (such as the self-employed). The current legislation also assures free choice of provider for the patient.

The Ministry of Public Health has elaborated a new health law (Health Reform Law. 95/2006) in its attempt to increase access to basic medical care, enhance the quality of medical services and improve the health indicators. Among other things, the 17 titles in this law aim to continue the decentralization process, to encourage the development of the private sector and to establish clear relations between the systems of health and social care. The private healthcare sector is in an incipient phase but growing at a high-speed.

An increasing number of private clinics have been opened and have been well received by those in the middle and upper income segments. Private companies usually offer private health insurance services to their employees, as part of the benefits package. In theory, insurance coverage is almost comprehensive. Exclusions comprise certain dental services and high-technology treatments. According to a communique remitted to ‘Nine O’Clock, ‘ the most recent IMAS survey ordered by MedLife shows that 20 per cent of Romanians living in urban areas use the private health system.

Over 70 per cent of them choose the private health system because of the quality of services offered. The other arguments in favour of their choice are: civilized conditions and cleanliness in private clinics (45. 7 per cent), the medical staff’s attitude (43. 1 per cent), the time it takes to receive medical care (39. 2 per cent), the private clinics’ high-performance technology (34. 2 per cent), the medical staff’s professionalism (30. 1 per cent), and the absence of informal payments (29. 3 per cent). The survey was conducted at national level on a sample of 1,000 persons on April 8-19, 2011.

According to the same survey, 61 per cent of respondents undergo medical check-ups one or several times per year, 19 per cent once every 2-3 years and 10 per cent once every 5 years or more. According to the survey, the best-known private hospital in Romania is the Life Memorial Hospital, followed by the Regina Maria Maternity, the Euroclinic Hospital, the Pelican Hospital in Oradea and the Arcadia Hospital in Iasi. The same survey reflects the frequency of visits to the doctor. Thus, compared to 2010, the percentage of Romanians that visit the doctor once a year has remained relatively constant, going from 20 per cent last year to 22.

6 per cent this year. On the other hand, the percentage of Romanians that do not visit the doctor at all dropped significantly, from 13 per cent in 2010 to 3 percent in 2011. The percentage of Romanians that visit the doctor several times per year has risen by approximately 15 per cent compared to 2010. About half of the Romanian citizens, mostly from Bucharest, have used at least once the private medical services. Although there is a high concentration of private hospitals in Bucharest area, the money gained from this region is almost equal to the profits in the rest of the country.