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Internal Affairs and Justice and the agencies related to national security. The DHIHs are mainly

responsible for concluding contracts with health service providers at the local level and

monitoring these contracts as well as certain quality aspects of service provision.

3.4.3 Other institutions

National School of Public Health, Management and Professional Development

The National School of Public Health, Management and Professional Development, Bucharest 6

(SNSPMPDSB) is a public institution dedicated to the education of public health professionals

and through these activities, to the improvement of health, prevention of diseases and

informed decision making by policy makers. SNSPMPDSB is providing courses on health

services management and administration, and consultancy on public health institutions

management.

National Institute of Public Health

The National Institute of Public Health 7 (INSP) has six regional public health centres and four

specialised national centres. Subjects covered by the national centres are: transmissible

diseases; risk monitoring in communities; evaluation and promotion of health; statistics and

information technology in public health.

3.5 Budget

The Romanian healthcare expenditures are among the lowest in the EU. Presented as a

percentage of GDP it is 4.95%, compared to 10.58% of the Netherlands and the EU average of

9.92% in 2015. In this, Romania is the lowest ranked country in the EU. Expenditure adjusted

for differences in purchasing power are EUR 865 per capita in Romania and EUR 3,857 per

capita in the Netherlands.

Household out-of-pocket payments are relatively high in Romania, 21% of health care

expenditures versus the Netherlands at 12% or the EU average at 15%. As a percentage of

GDP the out-of-pocket payments are comparable 1.3% in the Netherlands and 1.1% in

Romania. In total EUR 1.69bn is spent out-of-pocket on healthcare. This is partially due to

incomplete coverage of the public healthcare system, but to a large extent it represents

expenditures in private healthcare (private hospitals, dentists, and other private sector

healthcare providers). The out-of-pocket expenses presented here do not include informal

payments to healthcare providers in the public hospitals. It is very common in Romania to pay

health care providers under the table for services or pay for medicines that are part of the

treatment. These payments were already happening in the communist period and are still

6 Şcoala Naţională de Sănătate Publică, Management şi Perfecţionare în Domeniul Sanitar Bucureşti,

www.snspms.ro

7 Institutul Naţional de Sănătate Publică, www.insp.gov.ro

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