services for the general welfare of the population, the healthcare system, is in the same situation or even worse, if
we only consider that the population is growing older and, while the primary education system addresses a
smaller number of beneficiaries each year, the demand for the healthcare services is continuously growing. The
aim of this paper is not only to prove that, with a proper political volition and good management, the health care
system can survive, but also to propose some ways to achieve this.
Our approach starts from several statements proven to be correct in similar cases. One of them is: “if a
reliable solution is found, the financing could be assured”. Therefore, we believe that the main cause of the health
care system decline is not the lack of funds, but the misuse of the existing ones. Another hypothesis we base our
research on is that there is not only one problem of the health system, but several of them, for each social group,
region or type of disease. It is obvious that it is not possible or correct to set providing of high level medical
assistance both to the contributors to the medical care budget and to the non-contributors as the main goal, even if
this is against some political beliefs. Thus, in our opinion, the assurance of a minimum of services for the
disadvantaged categories and an average for the majority of the contributors is a fair target.
Another observation we will rely on is that the system should change in an intelligent way, which means that
no one should expect a one-step, total turn from low effectiveness to high performance, but a longer, iterative,
transformation.. The iterative process will take into account the response of the economical, social and political
environment to the stages performed and refine the objectives for the next steps according to this reaction. This is
why we suggest a spiral model, similar to some extent to the one introduced by Boehm in 1986 (Boehm, B.
1988).
Therefore, we will present a continuous and iterative approach for design, implementation and development
of the Romanian healthcare system. It is a holistic rather than a punctual view which does not focus on
institutional, tactical actions but on a coherent, continuously improving strategic process meant to increase the
quality of public services, building each new step upon asserting the reactions of the social environment and the
risks identified after the previous stage.