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Eurohealth, Vol.23, No.2, 2017 28 Eurohealth SYSTEMS AND POLICIES NEWMEASURESTOINCREASETHE HEALTH BUDGET IN ROMANIA By: Silvia Gabriela Scîntee, Cristian Vlãdescu and Cristina Hernández-Quevedo Summary: Romania’s health system is characterised by low funding and the inefficient use of public resources. There is a weak link between planning decisions and population health needs, due to a lack of appropriate information systems. The new government has increased the budget for health to: retain the health workforce by stopping the immigration of health workers, dedicate more funds to national health programmes, and ensure better access to medicines. It is hoped that the new measures considered by the recently-elected Romanian government will lead to better outcomes and that increased funding will lead to improved performance of the health system. Keywords: Health Budget, Workforce, Access, National Health Programmes, Romania Introduction dedicated mainly to improving access to medicines, initiating the building of The new Romanian government, which three regional hospitals and procuring came to power in December 2016, has medical technology for hospitals and increased the budget for health in order vaccines. 2 According to the 2017 budget, to achieve three main objectives on the the Statutory Health Insurance budget health policy agenda: 1 retaining the health administered by the National Health workforce by stopping immigration; Insurance House (NHIH) takes up 77% dedicating more funding to national health of public funds dedicated to health. programmes; and ensuring better access to This is 10.4% higher than the previous Silvia Gabriela Scîntee is Deputy medicines. These efforts are particularly year, with the main increase envisaged General Director at the School relevant for a country characterised by of Public Health, Management for home care (14.49%) and ambulatory an underfunded health system and it is and Professional Development, care (9.89%). 3 These focus areas are Bucharest, Romania; Cristian the first time an increase in health care in keeping with the National Health Vlãdescu is Professor of Public funding is linked to the stated objectives Health and Management at Strategy 2014 –2020 of increasing the of the government. the “Victor Babes” University volume of services provided within of Medicine and Pharmacy in ambulatory and community care settings Timisora and General Director In particular, the budget allocated for and of rationalising the use of hospital at the School of Public Health, health in 2017 increased by 23.5%, Management and Professional services. 4 Development, Bucharest, Romania; compared to the budget in 2016 Cristina Hernández-Quevedo is (from 30.28 to 37.4 billion lei / €6.7 to Romania ranks last among EU Technical Officer at the European €8.3 billion), representing a total health Observatory on Health Systems Member States in terms of total health expenditure of 4.7% of GDP (compared and Policies, LSE Health, London, expenditure (THE) per capita (€PPP 816 United Kingdom. to 4% in 2016). The increased budget is Email: [email protected] Eurohealth incorporating Euro Observer — Vol.23 | No.2 | 2017 Eurohealth SYSTEMS AND POLICIES 29 Figure 1: Health expenditure per capita in the EU (2014) 8000 Government/ compulsory insurance 7000 Private/ voluntary insurance 6000 5000 4000 1. Includes investments. 3000 2. OECD estimate. 2000 3. For Luxembourg, the population data refer only to the total insured 1000 resident population, which is somewhat lower than the 0 total population. 2 2 2 2 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1, 2 EU Italy Spain Latvia Finland Estonia France Sweden Greece Ireland Poland Malta Austria Croatia Cyprus Slovenia Portugal Germany Bulgaria Belgium Hungary Romania Denmark Lithuania Netherlands Luxembourg Czech Republic Slovak Republic United Kingdom Source: OECD Health Statistics 2016; Eurostat Database; WHO, Global Health Expenditure Database. per capita in 2015) and as a share of for the stewardship of the system and for pregnancy. Out of pocket (OOP) payments GDP (see Figure 1). THE as a share its regulatory framework. District public take the form of direct payments and of GDP has been decreasing steadily health authorities (DPHAs) represent informal payments. The share of OOP since 2010, influenced by the spending the MoH at the local level. Also at payments is the second largest source of cuts implemented to meet the country’s central level, the NHIH administrates revenue for health care spending (20%), fiscal deficit target and the unstable and regulates the SHI system and it is while the contribution of voluntary health political situation. Public expenditure represented at district level by district insurance (VHI) is marginal (0.2%). 5 The on health as a share of total public health insurance houses (DHIHs). 6 share of informal payments is thought expenditure (11.9%) is well below the to be substantial but unknown, although EU average (16.3%), although it has been recent legislative changes, which heavily increasing since 2011. The public sector incriminates both making and taking accounts for the largest part of THE informal payments, could have an impact. (78.9%), in line with the EU average (78.8%). Public sources account for 79% Increasing New measures to increase the of total health financing, converging with collection of funds the EU average. 5 incomealonewill The 2017 budget increase for health The Romanian health system notstop relies on some recent measures. Since in context February 2017, the national minimum immigrationof monthly wage has increased from 1,250 The Romanian health system is a social to 1,450 lei (from €278 to €322), and the health insurance (SHI) system that has healthworkers average gross monthly wage from 2,815 remained highly centralised despite recent to 3,131 lei (€625 to €696). 7 This follows efforts to decentralise some regulatory Although SHI is compulsory, it covers the trend since the second half of 2015, functions. The national level is responsible only 86% of the ‘‘population. Insured where successive increases of salaries for setting general objectives, while the individuals are entitled to a comprehensive in some public sectors, such as health, district level is responsible for ensuring benefits package while the uninsured are education, social assistance, public service provision. The Ministry of Health entitled to a minimum benefits package, administration, culture (ranging from 10% (MoH) is the central administrative which covers life-threatening emergencies, to 50% depending on the area) have authority in the health sector responsible infectious diseases, and care during been taking place. This latest measure is Eurohealth incorporating Euro Observer — Vol.23 | No.2 | 2017 30 Eurohealth SYSTEMS AND POLICIES expected to increase SHI contributions, as the share of VHI as a proportion of THE More funds for the national health they are paid as a percentage from gross already increased from 0.2% in 2012 programmes income (5.5% from gross salary and 5.2% to 0.6% in 2014. 9 Current national health programmes are from the employer, or 5.5% for the self- not contributing enough to increasing the employed). Implications for new legislation health status and satisfaction of patients. The preventive component is often weak Previously, the way SHI contributions Retention of health workforce and some important health problems, were calculated had a limit on the total Over the last decade, Romania has faced such as cardio-vascular diseases, are salary base used, set at five times the big waves of workforce emmigration. not included. Moreover, patients have average gross monthly wage. This Although there is a lack of precise data, difficulties accessing treatment offered favoured high earners who earned more the MoH issued over 43,500 certificates of under curative health programmes due to than this. This measure was recently conformity for health professionals in 2016 the fact that drugs can only be disbursed modified to eliminate the upper limit that offer the right to work in another after a complicated authorisation process. 6 for the health contribution calculation EU country. 10 base. According to the prime-minister, The Government Programme around 36,000 people with a monthly To counteract this trend, since 2015, there for 2017 – 2020 includes the introduction income higher than five average have been successive increases in health of a national programme for early gross wages would now pay a surplus workforce salaries. In addition, the new detection of cardio-vascular diseases and of 500 million lei per year (€111 million) government has set new allowances for establishing a dedicated budget for the to SHI. 8 different working conditions: 11 i.e. up treatment of rare diseases. A first step in to 85% of basic salary for those that apply improving existing health programmes is outbreak control measures, those exposed to include patients with advanced fibrosis to microorganisms and those that work under the new treatment (interferon free) Access in burns units; up to 70% for staff in for Hepatitis C. emergency departments, intensive care tomedicinesis units and psychiatric wards; up to 25% Another measure already taken is the for staff in infectious diseases, new-born simplification of drugs disbursement limitedfor and maternity wards, laboratories, stroke under the national health programmes. units, neurology and neurosurgery wards; Previously, the process to obtain patientsonlow and other allowances between 5 – 15% for reimbursement was cumbersome; different
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