No one can accuse the Romanian government of being lethargic when it comes to healthcare reform. After an unprecedented seven years of zero new molecules being admitted to the state reimbursement list, the pharma industry has suddenly been subjected to a whirlwind of radical refashioning and legislatory upheaval.
“The industry has changed more in the past six months than it has in the entire previous five years,” says Nolan Townsend, country manager of Pfizer Romania. “Such a pace of overhaul can, though, yield some nice results.”
“We’re talking about the reopening of 26 hospitals, 3,500 new jobs for health practitioners and a new list of subsided medicines, not to mention the introduction of a national health card and new national programs for urgent unmet needs.”
Nicolae Bănicioiu – Minister of Health
Fabrizio Giombini, managing director of MSD Romania, mirrors that sentiment. “Introducing originators to the local market has been a real challenge for innovative pharma companies for many years. There were several instances where access to innovation seemed imminent, only for desired reforms to fail to materialize. Eventually, last year, we finally made some tangible progress towards a new reimbursement system, though there remains considerable ground to cover,” he warns.
“I believe that we’ve achieved a great many milestones within a very tight timeframe. We’re talking about the reopening of 26 hospitals, 3,500 new jobs for health practitioners and a new list of subsided medicines, not to mention the introduction of a national health card and new national programs for urgent unmet needs,” declares Minister Bănicioiu.
“Not only did we introduce 40 new molecules last year – a feat simply unimaginable a few years ago – but also we have implemented an entire supporting architecture to enable similar updates to be conducted on a regular basis in the future: namely a delisting mechanism, cost-volume agreements and health technology assessment (HTA) capabilities,” emphasizes secretary of state at the Ministry of Health, Răzvan Vulcănescu.
Not everyone is so unequivocally optimistic, however, about Romania’s ability to propel itself forward in terms of healthcare outcomes. “The problem is that, in Romania, healthcare is all too often considered from a purely economic point of view: how much is spent on medicines. But the indirect social consequences should be factored in as well. If life expectancy remains one of the lowest in Europe or if the number of days spent on sick leave by workers remains abnormally high then this is going to harm the economy as a whole and translate into reduced productivity and a lower tax intake. Under such circumstances the end balance is a negative one,” argues Gabor Sztaniszlav, general manager of Amgen Romania. “We believe that, taking into account baseline GDP and underlying growth potential, Romanian society deserves to enjoy far better healthcare provision. And for that to happen there has to be more public money injected into the system,” he stresses.
Indeed, according to the European Health Consumer Index, which objectively evaluates the healthcare systems of the EU28 alongside a further eight non-EU European members, Romania now ranks 35th out of the 36 counties analyzed, with only Bosnia Herzegovina faring worse. “If you want a healthy economy you certainly need to invest money in healthcare because people constitute the main asset of a country,” affirms GSK’s general manager for Romania, Barbara Cygler. “The entire local industry has been built up in barely 20 years with the rapid emergence of a young medical class with high expectations, but we’re still waiting for that greater cultural paradigm shift that assigns healthcare its true worth as an investment in the nation,” reasons Roberto Musneci, senior partner at Serban and Musneci Associates (SMA).
“This is really problematic,” says Mark Dekker, Astellas’ country manager for Romania, “because unfortunately, there’s really no other substitute for introducing new liquidity into the system; none of the new mechanisms being embraced by the state will be able to overcome such a basic underfunding shortfall irrespective of how well they are applied.”