Can people afford to pay for health care? New evidence on financial protection in Romania
Overview
This review is part of a series of country-based studies generating new evidence on financial protection in Europe.
Financial protection is central to universal health coverage and a core dimension of health system performance. The incidence of catastrophic health spending is high in Romania compared to many countries in the European Union and higher than expected given Romania’s relatively low reliance on out-of-pocket payments to finance the health system. It is heavily concentrated among poorer households and older people, reflecting gaps in all three dimensions of health coverage (population entitlement, service coverage and user charges), weaknesses in purchasing policy and low levels of public spending on health.
Financial hardship is mainly driven by out-of-pocket payments for outpatient medicines and has increased over time, particularly among poorer households. To reduce unmet need and financial hardship, the Government should focus on improving the affordability of outpatient medicines (including over-the counter treatment) and dental care. This can be done by finding ways to:
- ensure the National Health Insurance House (NHIH) covers the whole population;
- introduce exemptions from co-payments for low-income households and people with chronic conditions;
- introduce an annual cap on all co-payments and link the cap to household income;
- improve NHIH purchasing policy;
- limit balance billing and extra billing; and
- pay attention to informal payments and service quality.
These efforts will require sustained increases in public spending on health. Any new additional funds should be carefully allocated to meet equity and efficiency goals.
