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Romania Health System Review Health Systems in Transition Vol. 10 No. 3 2008 Romania Health system review Cristian Vla˘descu • Gabriela Scîntee Victor Olsavszky Editors: Sara Allin • Philipa Mladovsky Editorial Board Editor in chief Elias Mossialos, London School of Economics and Political Science, United Kingdom and European Observatory on Health Systems and Policies Editors Reinhard Busse, Berlin Technical University, Germany Josep Figueras, European Observatory on Health Systems and Policies Martin McKee, London School of Hygiene and Tropical Medicine, United Kingdom and European Observatory on Health Systems and Policies Richard Saltman, Emory University, United States Editorial team Sara Allin, European Observatory on Health Systems and Policies Cristina Hernandez Quevedo, European Observatory on Health Systems and Policies Anna Maresso, European Observatory on Health Systems and Policies David McDaid, European Observatory on Health Systems and Policies Sherry Merkur, European Observatory on Health Systems and Policies Philipa Mladovsky, European Observatory on Health Systems and Policies Bernd Rechel, European Observatory on Health Systems and Policies Erica Richardson, European Observatory on Health Systems and Policies Sarah Thomson, European Observatory on Health Systems and Policies International advisory board Tit Albreht, Institute of Public Health, Slovenia Carlos Alvarez-Dardet Díaz, University of Alicante, Spain Rifat Atun, Imperial College London, United Kingdom Johan Calltorp, Swedish Association of Local Authorities and Regions, Sweden Armin Fidler, The World Bank Colleen Flood, University of Toronto, Canada Péter Gaál, Semmelweis University, Hungary Unto Häkkinen, Centre for Health Economics at Stakes, Finland William Hsiao, Harvard University, United States Alan Krasnik, University of Copenhagen, Denmark Joseph Kutzin, World Health Organization Regional Office for Europe Soonman Kwon, Seoul National University, Korea John Lavis, McMaster University, Canada Vivien Lin, La Trobe University, Australia Greg Marchildon, University of Regina, Canada Alan Maynard, University of York, United Kingdom Nata Menabde, World Health Organization Regional Office for Europe Ellen Nolte, London School of Hygiene and Tropical Medicine, United Kingdom Charles Normand, University of Dublin, Ireland Robin Osborn, The Commonwealth Fund, United States Dominique Polton, National Health Insurance Fund for Salaried Staff (CNAMTS), France Sophia Schlette, Health Policy Monitor, Germany Igor Sheiman, Higher School of Economics, Russia Peter C. Smith, University of York, United Kingdom Wynand P.M.M. van de Ven, Erasmus University, The Netherlands Witold Zatonski, Marie Sklodowska-Curie Memorial Cancer Centre, Poland Health Systems in Transition Written by Cristian Vlădescu, Victor Babes University of Medicine and Pharmacy, Timisoara Gabriela Scîntee, Centre for Health Policies and Services, Bucharest Victor Olsavszky, WHO Country Office in Romania Edited by Sara Allin, European Observatory on Health Systems and Policies Philipa Mladovsky, European Observatory on Health Systems and Policies Romania: Health System Review 2008 The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Keywords: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration ROMANIA © World Health Organization 2008, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Please address requests about this to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the WHO/Europe web site at http://www.euro.who.int/PubRequest The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the European Observatory on Health Systems and Policies to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the European Observatory on Health Systems and Policies be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the European Observatory on Health Systems and Policies. Printed and bound in the European Union. Suggested citation: Vlădescu C, Scîntee G, Olsavszky V, Allin S and Mladovsky P. Romania: Health system review. Health Systems in Transition, 2008; 10(3): 1-172. ISSN 1817-6127 Vol. 10 No. 3 Health systems in transition Romania Contents Preface ............................................................................................................v Acknowledgements ..................................................................................... vii List of abbreviations and acronyms ..............................................................ix List of tables and figures ...............................................................................xi Abstract ...................................................................................................... xiii Executive summary ......................................................................................xv 1. Introduction ..........................................................................................1 1.1 Geography and sociodemography .................................................1 1.2 Economic context ..........................................................................4 1.3 Political context .............................................................................8 1.4 Health status ...................................................................................9 2. Organizational structure .....................................................................21 2.1 Overview of the health system ....................................................21 2.2 Historical background ..................................................................21 2.3 Organizational overview ..............................................................24 2.4 Decentralization and centralization .............................................31 2.5 Patient empowerment ..................................................................33 3. Financing ...........................................................................................39 3.1 Health care expenditure ...............................................................41 3.2 Population coverage and basis for entitlement ............................46 3.3 Revenue collection .......................................................................49 3.4 Pooling and allocation to purchasers ...........................................65 3.5 Purchasing and purchaser–provider relations ..............................67 3.6 Payment mechanisms ...................................................................69 4. Regulation and planning ....................................................................73 4.1 Regulation ....................................................................................73 4.2 Planning and health information management ............................80 iii Health systems in transition Romania 5. Physical and human resources ...........................................................87 5.1 Physical resources ........................................................................87 5.2 Human resources .........................................................................90 6. Provision of services ........................................................................101 6.1 Public health ..............................................................................101 6.2 Patient pathways ........................................................................114 6.3 Ambulatory care .........................................................................115 6.4 Inpatient care .............................................................................116 6.5 Emergency care ..........................................................................120
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