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Chapter 3: The Romanian healthcare system

3.1 Introduction

In theory, Romania has a universal health coverage system, which means that the Romanian

government provides a specified package of health care services to the population at a

certain cost level. The insurance contributions are collected through the employers, the fee is

a percentage of the salary. The Health Fund contribution for the employer is 5.2% of the gross

salary, for the employee 5.5% of the salary subject to income tax. In principle all health

insurance contributing Romanians are entitled to free unrestricted health care, as well as

certain categories of non-contributing citizens - especially children and pensioners. People

outside these categories are only eligible for emergency medical care. In reality not all health

care services are covered by the public system and additional out of pocket expenditures are

required for certain treatments and medicine prescriptions. Private insurance schemes -

common to the Netherlands - are of minor importance in Romania. Next to the public

institutions there are a large number of private medical service providers e.g. dentists,

hospitals, laboratories.

3.2 The public sector

1

Until the revolution healthcare was managed through a Soviet-Union style Semashko system .

After the revolution Romania slowly reorganised the healthcare system into a social health

insurance system. In this system there are contractual relations between health care

providers and health care insurance houses. In anticipation of EU accession in 2007 all existing

legislation was abolished and brought together in Law 95/2006. This law has harmonized the

national legislation with the EU acquis communitaire. Further legislative development has

been limited. In 2012 a system overhaul was proposed to a Dutch model of regulated

competition. The proposed changes were never turned into legislation due to popular

protest, that led to the resignation of the Prime Minister.

The Ministry of Health is primarily responsible for healthcare in Romania. It is both

responsible for the regulatory framework and policies as well as the management of the

healthcare system at large. In the last 26 years the Ministry was headed by a total of 28

Ministers of Health, a very unstable political environment for the health sector. This instability

in the leadership is partly an explanation for a lack of policy execution and unfavourable

health outcomes for the Romanian people (see Chapter 2).

1 A public healthcare system where the government provides and funds all healthcare to the citizens and medical

staff are all employed by the government. Further characterised by a centralised, integrated and hierarchically
organisation structure.
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