Vladescu Cristian, Scintee Silvia Gabriela, Olsavszky Victor, Hernandez-Quevedo Cristina, Sagan Anna
University of Medicine and Pharmacy Victor Babes, National School of Public Health, Management and Professional Development.
National School of Public Health, Management and Professional Development.
Health Syst Transit. 2016 Aug;18(4):1-170.
This analysis of the Romanian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Romanian health care system is a social health insurance system that has remained highly centralized despite recent efforts to decentralize some regulatory functions. It provides a comprehensive benefits package to the 85% of the population that is covered, with the remaining population having access to a minimum package of benefits. While every insured person has access to the same health care benefits regardless of their socioeconomic situation, there are inequities in access to health care across many dimensions, such as rural versus urban, and health outcomes also differ across these dimensions. The Romanian population has seen increasing life expectancy and declining mortality rates but both remain among the worst in the European Union. Some unfavourable trends have been observed, including increasing numbers of new HIV/AIDS diagnoses and falling immunization rates. Public sources account for over 80% of total health financing. However, that leaves considerable out-of-pocket payments covering almost a fifth of total expenditure. The share of informal payments also seems to be substantial, but precise figures are unknown. In 2014, Romania had the lowest health expenditure as a share of gross domestic product (GDP) among the EU Member States. In line with the government's objective of strengthening the role of primary care, the total number of hospital beds has been decreasing. However, health care provision remains characterized by underprovision of primary and community care and inappropriate use of inpatient and specialized outpatient care, including care in hospital emergency departments. The numbers of physicians and nurses are relatively low in Romania compared to EU averages. This has mainly been attributed to the high rates of workers emigrating abroad over the past decade, exacerbated by Romania's EU accession and the reduction of public sector salaries due to the economic crisis. Reform in the Romanian health system has been both constant and yet frequently ineffective, due in part to the high degree of political instability. Recent reforms have focused mainly on introducing cost-saving measures, for example, by attempting to shift some of the health care costs to drug manufacturers by claw-back and to the population through co-payments, and on improving the monitoring of health care expenditure.
对罗马尼亚卫生系统的这一分析审视了其在组织与治理、卫生筹资、医疗服务提供、卫生改革及卫生系统绩效方面的近期发展情况。罗马尼亚医疗体系是一个社会医疗保险体系，尽管近期已努力将部分监管职能下放，但仍高度集中。它为85%的参保人口提供全面的福利套餐，其余人口可获得最低限度的福利套餐。虽然每个参保人无论社会经济状况如何都能获得相同的医疗福利，但在诸多方面，如城乡之间，医疗服务的可及性存在不平等，而且这些方面的健康结果也有所不同。罗马尼亚人口的预期寿命在增加，死亡率在下降，但两者在欧盟中仍处于最差之列。已观察到一些不利趋势，包括新增艾滋病毒/艾滋病诊断病例数增加以及免疫接种率下降。公共资金占卫生总筹资的80%以上。然而，这仍留下了占总支出近五分之一的可观自付费用。非正规支付的比例似乎也相当大，但确切数字不明。2014年，罗马尼亚的卫生支出占国内生产总值（GDP）的比例在欧盟成员国中最低。按照政府加强初级保健作用的目标，医院病床总数一直在减少。然而，医疗服务提供的特点依然是初级和社区护理供应不足，以及住院和专科门诊护理（包括医院急诊科护理）使用不当。与欧盟平均水平相比，罗马尼亚的医生和护士数量相对较少。这主要归因于过去十年工人大量移民国外，罗马尼亚加入欧盟以及经济危机导致公共部门工资削减使这一情况更加恶化。罗马尼亚卫生系统的改革一直在持续，但往往成效不佳，部分原因是政治高度不稳定。近期改革主要集中在引入成本节约措施，例如试图通过回扣将部分医疗费用转嫁给药品生产商，并通过共付费用转嫁给民众，以及加强对医疗支出的监测。
