Prime Minister Ilie Bolojan and Health Minister Alexandru Rogobete announced on Monday a comprehensive package of reforms for the healthcare system with 30 measures, aimed at correcting serious inefficiencies and directing resources towards the real needs of patients.
During a conference held at Victoria Palace, the two officials promised that patients will not be affected by budget cuts, despite efficiency measures, including the introduction of performance-based salaries for hospital managers and doctors.
Among the most important measures announced are:
- Recalculation of weighted case rates for hospitals with beds and increasing rates in outpatient care to encourage day treatment.
- Gradual elimination of personal contributions in private hospitals reimbursed by CNAS (co-payment).
- Transfer of costs to private hospitals in cases where patients are redirected to the public system within 48 hours.
- Sanctioning of fictitious reimbursements with penalties of up to 20% of the contract value and termination of employment contracts for involved doctors.
- Evaluation of managers and department heads based on clear performance indicators and assuming administrative responsibility for fictitious hospitalizations.
Spotmedia.ro presented, in live text format, the most important statements and decisions announced from Victoria Palace.
Ilie Bolojan, Prime Minister of Romania:
- I announced that this week we will announce the healthcare package. Our healthcare system has accumulated major problems in recent years, and there are two aspects affecting its proper functioning.
- Expenses allocated through CNAS to the healthcare system have reached a share of 60% compared to 11% in previous years. This year, we have a budget allocated of 77 billion lei, for which our colleagues have requested a supplement so that we can bring the bills up to date and operate until the end of the year. This means an additional 10 billion.
- This significant increase in funds does not directly reflect in the quality of services and in the perception and satisfaction of patients. These measures aim to solve a good part of these problems by addressing the causes that have brought us here.
- We have hospital managements that do not perform, and in many places, we have managerial inefficiency.
- We have disproportionately high wage expenses as a share of total hospital expenses. In conditions where salary expenses exceed 80-90%, the money remaining for all services in these hospitals is very limited, and practically these hospitals exist far too little for the patients they need to serve.
Performance criteria for managers
- Unfortunately, in many places, we have inflated services, we have fraud through various techniques that have often caused expenses to rise. We need to strengthen accountability.
- We have a delay in digitizing the system.
- We have privatization of gains.
- We have a lack of performance criteria in the system in terms of doctors' salaries. We will introduce performance-based salaries.
- We have overconsumption of medications, a significant share of innovative drugs both in volume much larger than necessary, and in terms of amount.
- In the coming days, we will present the other packages on the Government's agenda.
Alexandru Rogobete, Minister of Health:
- Efficiency in this system does not mean in any way that we will cut funds from patients. It does not mean in any way that we will leave hospitals without the necessary resources. It only means a reorganization of the system.
- I believe that for too many years the healthcare system has been patched up. So patched up that we can no longer afford piecemeal reforms. A real reform is needed to bring out the truth.
- Being the manager of a hospital is not a privilege. Just as being a department head is not a privilege. I have visited many hospitals where I have seen that it is possible. In the same country, with the same funding and the same Ministry of Health, some have shown that it is possible. I publicly urge managers who say it is impossible to make room for those who can and know how to do it.
- I am ashamed many times in front of patients who, despite a budget of 77 billion lei from CNAS, rapidly increasing in recent years, still in many hospitals, patients are sent to buy algocalmin. Basic paracetamol is not available in many hospitals.
- This is a systemic reform because there are exceptional people in Romanian medicine. This reform is about exceptions, about colleagues who at 11-12 leave the public hospital to treat their patients in private. The exceptions are those colleagues who take leave or unpaid leave to perform interventions in private hospitals. The measures we are talking about aim to increase the administrative apparatus of healthcare unit managers and to provide them with the opportunity to go as far as terminating the employment contract for those who do not respect their work schedule.
- There are over 30 measures just in the Ministry of Health area.
- A first measure: Recalculation of weighted case rates for bedded healthcare units for which payment is made per resolved case.
Free tests at private facilities
- Another measure: Gradual adjustment until the elimination of personal contributions for hospital medical services in private units reimbursed by the National Health Insurance House. Therefore, no co-payment.
- Revision of the methodology and minimum mandatory criteria for classifying hospitals based on competence to reflect new structures, competencies, and activities within bedded medical units, as well as defining new categories of hospitals, namely strategic hospitals, those hospitals that can provide polytrauma care, adequate treatment for stroke patients, acute myocardial infarction patients, critically ill newborns. We are talking about those hospitals where we can establish centers of excellence. Not every hospital should provide every type of medical service available in Romania.
- We have reached a point where we cannot cover shifts, we have hospitals with surgeons but without anesthetists or vice versa. We have reached an anomaly that has led us and continues to lead us to waste billions in the healthcare system. We have situations where doctors are dissatisfied with the public system.
Severe cases transferred to state at private expense
- Transfer of responsibility for paying the costs related to situations where a patient is discharged from a private medical facility and transferred or rehospitalized in the same type of care for similar pathologies within 48 hours of discharge to a public healthcare unit. The responsibility for paying the costs of these services will be transferred to the private medical unit that requested the transfer or caused the patient to be rehospitalized in the public healthcare unit.
- Imposition of a sanction and recovery of the value of medical services in case, during the contract period, the control structures of the Health Insurance Houses and the Ministry of Health report services that were not provided. The sanction will be a sum determined by a percentage of 10% of the hospitalization service value. The House will not pay 10% of the contract value if such cases of system fraud and fictitious service billing are identified.
- There are certain private healthcare units that bill CNAS for services with a figure just to understand the phenomenon, of 10 million lei, but invest in drugs, equipment, reagents, 10-20 thousand lei per month. This is not possible! For this reason, CNAS together with the Ministry of Health will conduct inspections and impose a 20% sanction on the contract value with the House.
- We cannot develop specialty outpatient care and day hospitalization without properly paying and reimbursing services from specialty outpatient care. We will increase the rate for medical services in specialty outpatient clinics from a value of 5 lei to 6.5 lei starting from August 1 and to 8 lei from January 1. This will lead to a significant increase in the number of diagnostic and treatment interventions performed in specialty outpatient care.
- Facilitating access for hospital department doctors to integrated outpatient activities at public hospital level by adopting an organizational level where all doctors, based on daily availability, can perform outpatient consultations without being conditioned by a preset schedule of hours. CNAS will remove this bureaucracy, where doctors have to announce their outpatient schedule by hourly intervals, and will leave it to the hospital managers and department heads to organize their activities.
- Evaluation of managers based on indicators assumed through the management project that becomes an annex to the contract and based on other non-negotiable indicators established by an additional order from the Minister of Health compared to the indicators they sign with the management contract with the local authority, respectively with the Ministry of Health.
- We will also introduce evaluation and performance indicators for department heads.
- Fictitious hospitalization: We come with a firm measure. Administrative sanctioning of fictitious hospitalizations with the termination of the department head's management contract and the termination of the employment contract of the doctor who fictitiously hospitalizes in public hospitals.
- I apologize to the patients who are sent at night to buy a vial of algocalmin because the public hospital, today, in 2025, with a record budget of the National Health Insurance House, cannot provide it.
Previously, the package of local public administration reform was announced on Friday evening by Prime Minister Ilie Bolojan and Development Minister Cseke Atilla.
- Ilie Bolojan announces local administration reform. Salaries cut, positions reduced, and efficiency bonus. Do you owe money to the city hall? Goodbye driver's license, social aid, or building permit!
- PSD draws the sword against Bolojan. Paul Stănescu: Stop the administrative terror! PNL responds: Daughters, sons-in-law, and mistresses have started to call