Public vs. private: healthcare services and subscriptions
This Monday, Questia Group focuses on the issue of healthcare. Namely, we discuss what types of healthcare services and subscriptions are Romanians using. Our research was made through an online survey on our platform www.questia.ro covering 1,494 respondents. The survey was active between the 28th of February and 3rd of March 2017. Our findings are presented below.
Short overview of the Romanian healthcare system
Over the years, the healthcare system in Romania has become a controversial issue. Since the 2011 proposal of its privatization when thousands of Romanian took it to the streets leading to the project’s withdrawal in January 2012; to the 2016 crisis due to the Hexi Pharma company that sold old watered-down hospital disinfectants at a marked up price- healthcare in Romania entangles many facets. In our study, we will focus on the types of healthcare Romanians choose, and why.
The Euro Health Consumer Index 2015 ranked Romania 32nd of 35 countries due to severe problems with management of the entire public healthcare sector. The World Bank reports that in terms of health outcomes, the health system is also below EU standards: coverage has increased, but the quality and results of the system are still far behind.
The healthcare system provides a comprehensive benefits package to the 86% 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 healthcare 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. That’s why some researchers call it “in transition”- see more here. According to the report, the main uninsured groups are people working in agriculture, those not officially employed in the private sector, the self-employed or unemployed who are not registered for unemployment or social security benefits and Roma people who do not have identity cards.
Moreover, Romania has the lowest health expenditure as a share of gross domestic product (GDP) among the EU Member State. In 2015, Romania spent only 5.6% of GDP on healthcare. The National Health Insurance Fund (NHIF) is funded by a combination of employer (5.2% of gross wages) and employee (5.5%) contributions, and allocations from the national budget. There are no reliable figures private spending, including the “informal” payments made by patients and their families to health care workers within the public health system.
Also, after Romania’s access to the EU, there was an increased trend of medical personnel leaving the country: over 14.000 doctors and 28.000 nurses have left Romania since 2009. Some of the main reasons the European Observatory report identifies are attributed to the lower salaries compared to non-health professions, low social status, lack of performance recognition, limited career development opportunities, and wide discrepancies between the levels of required competencies and working conditions that do not enable the skills acquired to be applied in practice (for example, lack of equipment and supplies).
In the last years, more and more companies have begun to offer private health insurance as an employment benefit. The number of private hospitals continues to grow also for those who afford to pay for the services themselves. The top 10 private clinics account for 35% of the private market, followed by smaller clinics and laboratories, and individual practices. Up to now, there are approximately 150 private hospitals in Romania.
According to our findings, the last visit to the doctor in the last 12 months was made to a state institution (48.8%) and a private institution (32.7%), with 18.5% of respondents declaring that they haven’t visited the doctor in the last 12 months. This highlights what the previous studies have pointed out: the degree of visiting private healthcare institutions are increasing. Moreover, in domains like dental services, almost 90% of the dental offices are private.
Out of those who have visited a private institution in the last 12 months, we were interested in finding out what types of subscriptions or services Romanians have. In this case, the data are quite insightful: 37.7% don’t have a subscription, but they prefer going to a private institution in case of emergency; 28.9% also don’t have a subscription, but they visit the family doctor. Moreover, 21.9% have a subscription to a private institution provided by the company/institution they work for. Only 6.4% have a personal subscription, and 4.1% have an individual insurance, via an insurance company, and less than 1% have other types of services. This shows that most don’t have subscriptions, but rather go on punctual visits to the doctor, or benefit from their employer’s.
However, according to the National Health Strategy 2014-2020 two important projects are in development in 2017: rural telemedicine and improving health system quality and efficiency. Thus, e-health and hospital management are two areas poised for growth, as Romania pursues “e-Health” solutions to improve the standard of care and control costs. See more in this issue here.
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