Romania’s Emergency Healthcare Ordinance: Papering Over Larger Cracks?

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State hospitals in Bucharest are increasingly overloaded with patients due to a lack of resources and specialists. This pressure is amplified by the fact that many Romanians turn to emergency services for even minor conditions. To rectify this situation, the Romanian state recently passed an emergency ordinance which allows private hospitals to offer emergency services while being paid by the state: one of the biggest reforms to the country’s health service in the past 30 years, but unlikely to provide a long-term solution to Romania’s underlying healthcare problems.

 

Stressed Public System

By law, the waiting time in the emergency departments of Romanian hospitals can be between 0 and 240 minutes, depending on the seriousness of the case. However, the death of a 70-year old woman after a 16-hour wait at a hospital in southern Romania crystallises the consequence of an overloaded public system.

Dr Adriana Nica, manager of the University Emergency Hospital Bucharest (SUUB) shares that in their case, “the number of patients [that the SUUB handles] exceeds 70,000 annually…and there are between 450 and 500 patients in the wardroom daily” in addition to all those present in the specialized ambulatory sections. In other words, there are more patients that the hospital can handle because “not everyone who comes to the ward daily is an emergency.” This means that around 40 percent of the cases at the SUUB are not genuine emergencies and could be solved by a visit to a specialized clinic or family doctor.

Moreover, health education is still a major issue in Romania as 25 non-emergency cases out of 100 call upon the attention of emergency medical services. The overloaded system inhibits hospitals in the allocation and optimisation of their resources. A fully-fledged diagnostic or prevention program would alleviate the system by educating the general population about alternatives but would also detect new cases of serious diseases such as cancer much earlier; in stage I or II, rather than III or IV, as is the case today.

 

Lack of Resources & Brain Drain

These issues are exacerbated by a lack of medical professionals, finances and equipment. Despite recent salary increases, many Romanian doctors prefer to work in better-paying Western European countries, creating a ‘brain-drain’ phenomenon within Romanian healthcare. Diana Păun, presidential advisor at the Department of Public Health, explains that: “clean hospitals, better conditions, adequate pay and better infrastructure” could help curb the medical exodus.

Among the problems in the public system are the lack of permanent specialised clinics and insufficient financial ceilings granted by the National Health Insurance House (CNAS). Other problems pointed out by Professor Dr Alina Tanase, manager of the Fundeni Clinical Institute, are the lack of medicines and the inefficient allocation of financial resources in the state system to hospitals that do not provide the services for which they receive money. All these factors contribute to current hospitals becoming overcrowded and not being able to provide adequate attention or services to patients in need.

 

The Emergence of Private Health Providers

Against this backdrop, the Romanian market for private medical services has been booming. The private healthcare sector boasts around 5,200 employees, over 2.8 million patients, a portfolio of about 500,000 medical subscriptions, 63 clinics, six hospitals, four centres with day hospitalization, three maternity hospitals, 8 medical campuses, 26 imaging centres, 33 analysis laboratories, its own stem cell bank and over 290 partner clinics in the country.

Networks such as Regina Maria, MedLife, Medicover and Sanador are benefiting from the increasing trend of patients with mid- to high-level incomes avoiding state hospitals marked by corruption, poor quality services and poor administration. These companies have dominated the landscape and are increasingly consolidating. MedLife, for example, has bought out 184 smaller firms.

 

The Emergency Ordinance

In order to relieve some of the pressure on the public system and better utilise Romania’s burgeoning private market, on February 4th, 2020 the country’s Liberal Government led by Prime Minister Ludovic Orban adopted an emergency ordinance allowing private hospitals to provide emergency medical services paid for by the state.

The ordinance, drafted by Minister of Health Victor Costache, also allows private hospitals to participate in national programs for the treatment of chronic diseases, such as cancer, HIV/AIDS, tuberculosis and cardiovascular diseases, for which the costs are also covered by the state. Previously, private hospitals were only allowed to participate in these programs when the capacity of public hospitals was exceeded.

Opposition politicians have criticized the ordinance, claiming that it represents the “privatization” of the public healthcare system and would lower available funds for public hospitals.

 

A Long-Term Solution?

As of today, the Romanian public health sector is stretched thin and unable to provide adequate services to patients in need. Private healthcare providers have stepped in and carved out a growing market share by offering valuable services to citizens who have the means to pay out of their pocket for medical treatments and consultations. This leaves less affluent citizens – Romania remains a country with one of the lowest per capita incomes within the EU – at a disadvantage and creates a bigger health inequality gap within the country.

The Emergency Ordinance – which some commentators are calling one of the biggest health reforms in the country since the 1989 Velvet Revolution – has sought to rectify this. However, this is yet another attempt at managing a crisis rather than tackling the underlying issue dominating the healthcare ecosystem in the country: drafting and implementing a healthcare strategy that extends beyond the duration of a single government or Minister of Health.

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