ROMANIA

The Romanian health care system is a social health insurance system that has remained highly centralized despite recent efforts to decentralize some regulatory functions. It provides a comprehensive benefits package to the 85% of the population that is covered, with the remaining population having access to a minimum package of benefits. While every insured person has access to the same health care benefits regardless of their socioeconomic situation, there are inequities in access to health care across many dimensions, such as rural versus urban, and health outcomes also differ across these dimensions.

Public sources account for over 80% of total health financing. However, that leaves considerable out-of-pocket payments covering almost a fifth of total expenditure. The share of informal payments also seems to be substantial, but precise figures are unknown.

The Romanian health system is organized at two main levels, national and district, mirroring the administrative division of the country, with the national level responsible for setting general objectives and the district level responsible for ensuring service provision according to the rules set at the central level. The system remains highly centralized, with the Ministry of Health being the central administrative authority in the health sector responsible for the stewardship of the system and for its regulatory framework. The Ministry of Health also exerts indirect control over some functions that have been recently decentralized to other institutions and that are only just beginning to assert regulatory functions, such as the National Authority for Quality Management in Health Care. District public health authorities (DPHAs) represent the Ministry of Health at the local level. The other key actor at the central level is the National Health Insurance House (NHIH), which administrates and regulates the social health insurance system. This organizational structure has been in place since 1999, having replaced the Semashko model. The NHIH is also represented at district level by district health insurance houses (DHIHs).

While social health insurance is in principle compulsory, in practice it covers only around 86% of the Romanian population, the main uninsured groups being people working in agriculture or those not officially employed in the private sector; the self-employed or unemployed who are not registered for unemployment or social security benefits; and Roma people who do not have identity cards. Insured individuals are entitled to a comprehensive benefits package while the uninsured are entitled to a minimum benefits package, which covers life-threatening emergencies, epidemic-prone/infectious diseases and care during pregnancy.
Primary care physicians own their practices and receive payments based on a mix of age-weighted capitation and fee-for-service (FFS). Ambulatory care specialists who own their practice and have entered into contracts with the DHIHs are paid on a FFS basis, but specialists working in hospital ambulatory units receive a salary, as do other hospital physicians. Nurses are paid a salary in both the public and private health care sectors. Hospitals receive prospective payments consisting of a mix of payment methods, including the Romanian diagnosis-related groups (RO-DRG) system. Emergency services and certain public health care services are paid from the state budget. ( HiT )