EFECTIVE ADVOCACY FOR HEALTH Bled, Slovenia April 2224, 2004 Working Group SEE Public Health Policy

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EFECTIVE ADVOCACY FOR HEALTHBled,
SloveniaApril 22-24, 2004Working Group - SEE
Public Health Policy Discussions Healing the
Crisis

• CRISTIAN VLADESCU
• Center for Health Policies and Services, Romania

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OVERVIEW OF HEALTH CARE SERVICES IN ROMANIA

• 1. Burden of disease morbidity and mortality
• Increased mortality increased SMR by
  cardiovascular disease disease due to behavior
  risk factors that are responsible for most DALY
  lost and which have a relative high potential of
  being avoided.
• Increased incidence for communicable diseases
  (TB, STDs, etc.)
• Development of National Health Programs
• Dedicated programs for surveillance of
  communicable diseases
• Inter-sectoral health programs (anti-smoking,
  health promotion, etc.)

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Life Expectancy
4
Ratio of Death Rates / 1000 inhabitants
5
SMR from cardio-vascular diseases
6

• 2. Resources
• Important public capital investments in Hitech
  equipment for hospitals (over 500 millions USD in
  the last 3 years)
• Concordance with EU requirements for basic
  training for medical professionals (there are
  differences concerning specialty training and
  competences)
• Human resources unequal coverage with medical
  staff among different regions.
• Poor endowment with basic medical technology in
  primary health care units.
• Too many acute beds in the system and fewer long
  term beds/units

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No. of Physicians / 100,000 locuitori
8

• 3. Organization
• Purchaser-Provider split in health care services
• Inception of the decentralization of process
  towards local councils
• Increased freedom of choice for consumers
• Lack of stability in the decision-making
  process(14MoH in 14 years)
• Mismatch between people health care needs and
  health services structure
• Too many types of health care facilities
• Overuse of some services and lack of efficiency
  for others
• Excessive focus on hospital services in detriment
  to the outpatient and community services
• Lack of institutional patterns for alternative
  care
• Poor horizontal and vertical integration of
  providers
• Reduced involvement of private sector in health
  care both at providers and insurers level
• Lack of responsiveness and accountability of the
  system

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ROMANIAN HEALTH CARE SYSTEM CHART
Court of Account
College of Physicians College of Pharmacists
National Health Insurance House
Ministry of Health
Ministry of Finance
Ministry of Labour and Social Protection
District Council Local Council
District Health Insurance House
College of Physicians College of
Pharmacists -district branch-
District Public Health Authority
Prefect District Executive Council
District Public Finance Department
District Dpt. of Labour and Social Protection
(b)
(a)
(c)
Joint Commission of Quality Control and
Accreditation
Ambulatory Care
Primary Health Care
Hospitals
control contracts
subord. colab.
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• 4. Financing
• Increased funds allotted to the health care
  sector in the last 3 years
• Implementation of the new financing mechanism for
  PHC
• Piloting of new financing mechanisms at hospital
  level (DRG)
• Lack of transparency and clear performance
  criteria in resource allocation both at macro and
  micro level
• Still relative low share of GDP allotted to
  health care (in comparison with accession
  countries and UE)
• Reduced mechanisms for supporting private
  investment in health.
• Important private contribution in health care
  financing (1/4 of total).

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Health care expenditure as from GDP
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CONCLUSIONS AND (POSSIBLE) RECOMMENDATIONS

• Development of a clear and shared vision for the
  health care system, consistent with the
  governments goal of improving health in a
  sustainable and credible manner.
• A coherent legal and regulatory framework, based
  on transparent criteria of equity and efficiency
  should be developed, in order to order to
  increase the accountability and responsiveness of
  health system to the needs of the population.
• Building management capacity at central, local
  and organizational level. Skills in strategic
  planning and evaluation, decision-making,
  leadership, practice management need to be
  developed system wide.
• Enhancing primary health care, preventive
  services, health promotion and health education
  and target the poor. Shifting the emphasis away
  from curative, inpatient interventions would have
  efficiency and equity benefits.

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• Develop integrated health care and social
  programs addressing the needs of specific groups
  stimulating functional integration and
  coordination among different levels and types of
  social and health services.
• Moving away from unofficial payments.
• Develop a national drug policy ensure
  availability and affordability of drugs,
  especially for poor and marginal groups and in
  rural areas
• Develop an inter-sectoral approach to health and
  encourage a real partnership with the civil
  society, private sector and other international
  organizations.

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Health Care Systems Performance Review in
Countries members of the W.H.O. (2000)