• Spending overview
• Policy overview
• Diseases overview

Spending overview

Total expenditure on healthcare is estimated at 5.5% of GDP in 2008, which is low even by the standards of the region. Expenditure on healthcare is estimated at about US$512 per head in 2008, compared with over US$900 in Poland and over US$1,200 in Hungary. Annual healthcare spending is expected to rise gradually in 2011-14, as Romania recovers from the economic crisis, to about 5.8% of GDP by 2014, but this will still be well below average EU levels of 8.5% of GDP. Moreover, regional differences in healthcare spending are significant, with spending per head about twice as high in the capital, Bucharest, as in the north-east of the country. Nevertheless, by 2014 nominal healthcare spending per head is expected to be worth about 50% more than in 2008, as Romania attempts to align its health system with that of the EU, disposable incomes rise, private health insurance takes off and medicine consumption increases from the current low levels.

The healthcare system is almost entirely owned by the state, and is funded by a combination of employer and employee contributions to the National Social and Health Insurance Fund (CNAS), and of direct allocations from the state budget. Health reforms began in the mid-1990s and encouraged the development of primary care, introduced an insurance-based system of financing, and separated the purchasing and provision of healthcare, but there is still little competition in health service provision.

Government spending has accounted for about 66% of total expenditure on health. According to the World Health Organisation (WHO), out-of-pocket spending on healthcare accounted for around 85% of private expenditure on healthcare in 2006 and under-the-table payments to healthcare staff are common in order to gain preferential access to treatment. Parliament passed a law on private health insurance in 2004 and there is a small but growing private healthcare sector. Private clinics have opened and have been well received by those in the middle- and upper-income segments.

Policy overview

Since 1990 public expenditure on health has been low, below the average even for eastern Europe. This has had a negative impact on the maintenance of the health system, investment in new equipment and access to services, especially for low-income groups. Public satisfaction with the health system is extremely low. The system is underfunded and plagued by long waiting times. It is also inequitable: treatment is more accessible to those with money and the right contacts.

Reforms initiated by the Social Democratic Party (SDP) government in 2003 to rationalise and consolidate the system resulted in severe budget cuts, which led to nationwide public protests. Currently, further reform plans are being discussed—namely, to foster greater decentralisation of the healthcare system by giving more responsibility for the management of hospitals to local authorities, and to introduce a system of co-payments for out-patient and hospital treatment. It is hoped that the system of co-payments will partly ease funding difficulties in hospitals and help to rationalise demand for medical treatment. The government is also encouraging public-private partnerships in the construction of new hospitals and for specialist facilities such as dialysis.

Diseases overview

These low levels of spending correspond with mediocre healthcare indicators: life expectancy is estimated at 72.5 years in 2009 and infant mortality at 11 per 1,000 live births in 2009, poor even by the standards of the region. Although the population has been declining moderately overall, this does not indicate a fall in the need for health services, because the percentage of the population above 65 years of age is increasing.

Although the main causes of death are similar to those in industrialised societies, including cardiovascular disease and cancer, communicable diseases such as tuberculosis remain common. The number of hospital beds per 1,000 people has declined in recent years as a result of hospital cuts, from 7.5 per 1,000 people in 2002 to around 6.4 per 1,000 people today, a number that is close to the EU average.