Healthcare System (Romania)

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The Romanian healthcare system operates under a social health insurance model, aiming for universal coverage. However, in practice, it covered 89% of the population as of 2017. The system is governed by the Ministry of Health and administered by the National Health Insurance House (NHIH). Both these bodies are represented locally through district public health authorities and district health insurance houses (DHIHs).

The healthcare system is financed from four main sources: national health insurance funds, the state budget, local budgets, and out-of-pocket (OOP) payments. OOP payments include direct payments for private services, co-payments for medicines, and potentially sizable informal payments.

The benefits provided by this system encompass a range of services. Primary care is provided by family physicians, who play a gatekeeper role, although direct access to specialists is possible for certain conditions. Specialist consultations, hospital care, and emergency services are provided by a network of various providers, such as outpatient departments, polyclinics, and specialized medical centers, but access can be uneven, with rural areas facing more challenges than urban areas.

To be eligible for these benefits, individuals must contribute to the national health insurance fund, a mandate that applies to employees, employers, and the self-employed. Certain groups like students, pensioners, and unemployed individuals receive state-funded health insurance.

Data management has been digitalized with the creation of national electronic systems for medical prescriptions and the insured. Hospitals and clinics are obliged to maintain patient records and are transitioning to Electronic Health Records (EHRs). The system faces challenges, including data standardization and interoperability across different healthcare providers.