4.2 Romanian reality and past experiences
The target of this paper – the Romanian health care system – inherits the problems and challenges of the
European one and adds a lot of others, specific to the country and the geopolitical region Romania belongs to. As
we know, the communist era set up a health system based on social accessibility and equal treatment of the
citizens, or at least these were the stated defining principles. It was financed from the national budget, which was
predictable and planned on a five-year basis, together with all the other sectors of economy or social assistance,
the resulted plan being compulsory (imposed by law) for everybody. We do not intend to debate how this system
worked, but to show that none of its existing conditions have been maintained until today. As a main
consequence, the structure of the health system must be totally redesigned which is definitely a long term,
strategic process. This is the main causes for which in the last two decades the health care system has been a
hybrid, at least in terms of resources. It means that the health contributions have been collected to a central fund,
administrated by the government, who has decided upon allocation, and established an upper limit of expenditure
always lower than the amount collected. This has caused a continuous crisis with some severe situations, such as
the late reimbursement by National Health Insurance Office of the expenditures with compensated medicines.
The independence of the Health Insurance Fund from the Ministry of Finance has increased since 2003
(excepting 2006 and 2007) but the continuously growing expenditures with the health services became a heavy
burden for the government, as shown in Figure 1