Romania RO Country Health Profile 2019 the Country Health Profile Series Contents

State of Health in the EU Romania RO Country Health Profile 2019 The Country Health Profile series Contents The State of Health in the EU’s Country Health Profiles 1. HIGHLIGHTS 3 provide a concise and policy-relevant overview of 2. HEALTH IN ROMANIA 4 health and health systems in the EU/European Economic 3. RISK FACTORS 7 Area. They emphasise the particular characteristics and challenges in each country against a backdrop of cross- 4. THE HEALTH SYSTEM 9 country comparisons. The aim is to support policymakers 5. PERFORMANCE OF THE HEALTH SYSTEM 13 and influencers with a means for mutual learning and 5.1. Effectiveness 13 voluntary exchange. 5.2. Accessibility 16 The profiles are the joint work of the OECD and the 5.3. Resilience 19 European Observatory on Health Systems and Policies, 6. KEY FINDINGS 22 in cooperation with the European Commission. The team is grateful for the valuable comments and suggestions provided by the Health Systems and Policy Monitor network, the OECD Health Committee and the EU Expert Group on Health Information. Data and information sources The calculated EU averages are weighted averages of the 28 Member States unless otherwise noted. These EU The data and information in the Country Health Profiles averages do not include Iceland and Norway. are based mainly on national official statistics provided to Eurostat and the OECD, which were validated to This profile was completed in August 2019, based on ensure the highest standards of data comparability. data available in July 2019. The sources and methods underlying these data are To download the Excel spreadsheet matching all the available in the Eurostat Database and the OECD health tables and graphs in this profile, just type the following database. Some additional data also come from the URL into your Internet browser: http://www.oecd.org/ Institute for Health Metrics and Evaluation (IHME), the health/Country-Health-Profiles-2019-Romania.xls European Centre for Disease Prevention and Control (ECDC), the Health Behaviour in School-Aged Children (HBSC) surveys and the World Health Organization (WHO), as well as other national sources. Demographic and socioeconomic context in Romania, 2017 Demographic factors Romania EU Population size (mid-year estimates) 19 587 000 511 876 000 Share of population over age 65 (%) 1 7.8 19.4 Fertility rate¹ 1.7 1.6 Socioeconomic factors GDP per capita (EUR PPP²) 18 800 30 000 Relative poverty rate³ (%) 23.6 16.9 Unemployment rate (%) 4.9 7.6 1. Number of children born per woman aged 15-49. 2. Purchasing power parity (PPP) is defined as the rate of currency conversion that equalises the purchasing power of different currencies by eliminating the differences in price levels between countries. 3. Percentage of persons living with less than 60 % of median equivalised disposable income. Source: Eurostat Database. Disclaimer: The opinions expressed and arguments employed herein are solely those of the authors and do not necessarily reflect the official views of the OECD or of its member countries, or of the European Observatory on Health Systems and Policies or any of its Partners. The views expressed herein can in no way be taken to reflect the official opinion of the European Union. This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. Additional disclaimers for WHO are visible at http://www.who.int/bulletin/disclaimer/en/ © OECD and World Health Organization (acting as the host organisation for, and secretariat of, the European Observatory on Health Systems and Policies) 2019 2 State of Health in the EU · Romania · Country Health Profile 2019 1 Highlights ROMANIA Although it has increased, Romania has among the lowest life expectancy in the EU. This reflects unhealthy behaviours, but also socioeconomic inequalities as well as substantial deficiencies in health service delivery. The Social Health Insurance system provides a comprehensive benefit package – however, about 11% of the population remains uninsured and is entitled to only a minimal basket of services. Key challenges for the health system include fixing the imbalance between primary care and hospital care, and tackling the growing shortages of health professionals. RO EU Health status 809 81 Life expectancy at birth in Romania has increased by more than four years since 2000 (from 71.2 years to 75.3 years in 2017). However, there are large 773 disparities in life expectancy by gender and education level, particularly 76 753 for men: the least educated men can expect to live about 10 years less 712 than the most educated. Ischaemic heart disease remains the main cause 71 2000 2017 of death, although cancer mortality is on the rise. Romania also faces Life expectancy at birth, years challenges in controlling some infectious diseases, with the highest rate of tuberculosis cases in the EU. Countr %01 %01 EU RO EU Risk factors Around half of all deaths in Romania are attributable to behavioural Smon 20 % 19 risk factors. One in five Romanian adults are daily smokers, with a much higherEU rate among men (32 %) than women (8 %). Adult obesity rates Bne drnn 35 % 20 are amongCountr the lowest in the EU (10 %), but overweight and obesity rates Obest 10 % in children have increased over the last decade to reach 15 %. Alcohol 15 consumption is a major public health threat, with the binge drinking rate % of adults (35 %) far exceeding the EU average of 20 %. In men, this rate is over 50 %. RO EU Health system EUR 3 000 Health spending in Romania is the lowest in the EU, both on a per capita basis (EUR 1 029, EU average EUR 2 884) and as a proportion of GDP (5 %, EURSmon 2 000 17 EU 9.8 %). The share of publicly financed health spending (79.5 %) is in EUR 1 000 line with the EU average (79.3 %), and while out-of-pocket payments EUR 0 Bne drnn 22 2005 2011 2017 are generally low, except for outpatient medicines, informal payments are both substantial and widespread. In absolute terms, spending in all Per capita spending (EUR PPP) Obest 21 sectors is low and the health system is significantly underfunded. Effectiveness Accessibility Resilience The death rates from preventable A substantial proportion of the The long-standing and treatable causes are among population reports unmet needs over-reliance on the highest in the EU. More for medical care; moreover, there inpatient care effective public health and are significant regional, ethnic contributes to an prevention policies, and an and income-related disparities in inefficient health enhanced role for primary care access. People in rural areas, those system. Primary care is both and improved access to services, from marginalised communities, under-resourced and underused, could substantially reduce and lowerCountr socioeconomic groups, but there are attempts to premature mortality. all faceEU greater barriers to care. reallocate resources towards primary care. Performance Prevent ble 310 Hh ncome All Low ncome assessment of the health system mort lt 157 RO is not generally undertaken, Tre t ble 208 EU making it difficult to steer mort lt 93 RO EU improvements. Age-standardised mortality rate 0% 3% 6% 9% per 100 000 population, 2016 % reporting unmet medical needs, 2017 State of Health in the EU · Romania · Country Health Profile 2019 3 2 Health in Romania ROMANIA Life expectancy has increased, but lags women living on average seven years longer than men almost six years behind the EU average (71.7 years compared to 79.1). While life expectancy at birth in Romania increased Romania has one of the highest rates of infant by more than four years between 2000 and 2017 (from mortality in the EU – 6.7 per 1 000 live births 71.2 years to 75.3 years), it remains among the lowest compared to the EU average of 3.6 in 2017. Insufficient in the EU and almost six years below the EU average medical equipment and the shortage of doctors may (Figure 1). There is also a marked gender gap, with help to explain this figure (see Section 5.3). Figure 1. Life expectancy in Romania is among the lowest in the EU Yers 2017 2000 90 – Gender gap: Romania: 7.4 years 85 – 834 831 EU: 5.2 years 827 827 826 825 824 822 822 821 818 817 817 816 816 814 813 812 811 811 809 80 – 791 784 78 7 78 773 76 758 753 749 748 75 – 70 – 65 – EU Sp n Itl Frnce MltCprusIrelnd Greece Polnd Ltv NorwIcelndSweden Austr F nlndBel um Czech Eston Crot Bul r Portu l Sloven GermnDenmr Slov Hun rL thun Romn Luxembour Netherlnds Un ted n dom Source: Eurostat Database. There are stark inequalities in life Figure 2. Men with low education die 10 years earlier expectancy by educational level than those who are tertiary educated Differences in life expectancy across educational levels are substantial, particularly for men. As shown in Figure 2, men with low levels of educational attainment at age 30 live on average 10 years less 516 than those with high education, considerably higher 478 ers 469 ers than the EU average of 7.6 years. The gap among ers 37 2 women is much less pronounced — about four years, ers which is around the same as across the EU (Figure 2). Lower Higher Lower Higher educated educated educated educated women women men men Education gap in life expectancy at age 30: Romania: 3.8 years Romania: 9.7 years EU21: 4.1 years EU21: 7.6 years Note: Data refer to life expectancy at age 30.

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