Romania, which joined the European Union on 1 January 2007, began the transition from Communism in 1989 with a largely obsolete industrial base and a pattern of output unsuited to the country’s needs. The country emerged in 2000 from a punishing three-year recession thanks to strong demand in EU export markets. Domestic consumption and investment have fueled strong GDP growth in recent years, but have led to large current account imbalances. Romania’s macroeconomic gains have only recently started to spur creation of a middle class and address Romania’s widespread poverty. Corruption and red tape continue to handicap its business environment. Inflation rose in 2007-08, driven in part by strong consumer demand and high wage growth, rising energy costs, a nation-wide drought affecting food prices, and a relaxation of fiscal discipline. As a result of the global financial crisis, Romania’s GDP fell more than 7% in 2009, prompting Bucharest to seek a $26 billion emergency assistance package from the IMF, the EU, and other international lenders. Drastic austerity measures, as part of Romania’s IMF-led agreement, led to a 1.3% GDP contraction in 2010. The economy returned to positive growth in 2011.

The local healthcare industry encountered the same difficulties as in all the Central and Eastern Europe (CEE) healthcare systems: a low level of government financing, inadequate and obsolete equipment and facilities, management deficiencies, informal payments all the aforementioned resulting in an overall increasing dissatisfaction of population.

At present, Romania’s healthcare system is still dominated by the public healthcare system, being funded by a combination of employer and employee contributions to the National Health Insurance Fund (NHIF) and of direct allocations from the state budget. Romania has a mandatory insurance-based financing model for healthcare, involving contributions from employers (5.2% of the gross wage) and employees (5.5% of the gross wage). The health insurance system is administrated and regulated by NHIF, a central quasi-autonomous body.

The representative bodies of the Ministry of Public Health at the district level are the 42 district public health authorities (DPHAs). Also at district level, 42 District Health Insurance Funds (DHIFs) are responsible for contracting services from public and private healthcare providers according to the rules set by the central units. Two national insurance funds have been established in 2002, one belonging to the Ministry of Transport (CAST) and the other to the Defence System, Public Order, National Security and Justice (OPSNAJ Authority). Since 2002, the social insurance contributions have been collected at the national level by a special body under the Ministry of Finance (the Fiscal Administration National Agency), and DHIFs have raised contributions only from insured persons paying the whole contribution (such as the self-employed). The current legislation also assures free choice of provider for the patient.

The Ministry of Public Health has elaborated a new health law (Health Reform Law. 95/2006) in its attempt to increase access to basic medical care, enhance the quality of medical services and improve the health indicators. Among other things, the 17 titles in this law aim to continue the decentralization process, to encourage the development of the private sector and to establish clear relations between the systems of health and social care.

The private healthcare sector is in an incipient phase but growing at a high-speed. An increasing number of private clinics have been opened and have been well received by those in the middle and upper income segments. Private health insurance services are usually offered by private companies to their employees, as part of the benefits package. In theory, insurance coverage is almost comprehensive. Exclusions comprise certain dental services and high-technology treatments.

The number of hospitals has remained relatively constant since 1980, when 416 hospitals were registered by the Centre for Health Statistics of the Ministry of Public Health, whilst in 2005 the total number was 433. Very few new state-owned hospitals were built after 1989.

Most hospitals are state-owned, with new hospitals being opened by the private investors. Capital investment projects are decided at Ministry of Public Health level on the basis of proposals submitted by districts, being funded through taxation (and paid out of the state budget) with the additional support from external funded programs and donations. The government has also announced its support regarding public-private partnerships in the construction of new hospitals and specialized facilities such as dialysis, although no project has been completed so far.

Due to the underfunding of the system, it is generally accepted that the quality of hospital buildings and equipment is either obsolete or overused. The substantial amounts invested by the Ministry of Health during the past years in purchasing new and modern equipment are yet insufficient and unevenly distributed. Significant investments in new technologies and up-to-date medical equipment can be seen in the recently opened private clinics, which are becoming main alternatives to the formerly renowned “top clinics” in the public sector, with long traditions in health care.

Romania has a doctor-to-patient ratio of below 2 per 1,000 inhabitants, which is lower than European average. Shortages are most acutely felt in rural areas. Lately, since Romania has joined EU, the migration of healthcare personnel to western countries has amplified, decreasing even more the ratio and the patients’ options to access better-quality medical services. Because the general funding crisis in the healthcare system, the medical professionals’ situation has deteriorated, often receiving wages with considerable delays. Although some 96% of Romanians are registered with a doctor, primary care remains poor. Additionally, there is a shortage of pharmacists, which pushes more patients to see hospital doctors.