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practised. Patients hope to get a better treatment by making these payments. The informal

payments themselves vary a lot, from a box of chocolates for a nurse to sums of money for a
doctor.

3.6 Issues in the healthcare system

There are several “issues” in the Romanian healthcare system that cause the low health

outcomes at the bottom of EU rankings.

System wide issues

1. Funding of the system: as discussed above; in comparative perspective little money is

spent in the public healthcare system.

2. Management of the system: due to political chaos and a fast-track turnover of

ministers of health. Resulting in none or hardly any improvement of the system.

3. Policies for the system: the health strategy looks beautiful on paper, but execution of it

is pretty much absent.
It is unlikely that these system wide issues will be changed in the short term. In the reality of

today many Romanians are getting more and more disappointed in their country and leave.

After the revolution, a flow of emigrants developed. By now 18.2% of the population

emigrated 8 , both lower educated and higher educated people. Over a quarter (26.6%) of the

population with a higher education left the country, this created a serious “brain drain” When

these higher educated are asked why they do not want to return to Romania the political

environment is
one of the major reasons. Today the higher educated Romanians are finding

quality jobs in western countries and sent their children to western universities. They no

longer see a valuable future in their country of birth. Many Romanian doctors and other

medical staff have left the country for a better future abroad. France has the largest inflow of

Romanian doctors. The outflow of medical staff has led to shortages in Romanian healthcare.

medication and parallel trade
Access to

In Romania the price for medicines is set by the National Agency for Medicines and Medical

Devices (ANMDM). For certain medicines the set price is so low, that pharmaceutical

companies are withdrawing their medicines from the market by deregistering them with the

A

ANMDM. number of important medicines are not available on the Romanian market

anymore, hampering the recovery of patients. The website of the Romanian Health

Observatory (www.health-observatory.ro) has more information. It is estimated that

pharmaceutical companies took 2,000 medicines off the market. The governmental

interventions lead to a flourishing parallel market. Medicine priced in Romania at a relatively

low price are exported to other countries where they are sold at the relatively higher price

8 For more information on this section see: The World Bank, Andrei Dospinescu and Giuseppe Russo; Romania –

Systematic Country Diagnostic: background note – migration; 2018.

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