Health reform, between public and private

The new Health Law is a project that, according to the initiators, is working hard on and that should finally bring quality in a medical system where the budgets allocated grow from year to year.

New clarifications and explanations were made ​​at a topic conference organized by Mediafax.

After meetings and consultations of the Ministry of Health with representatives of civil society and health professional organizations have emerged some ideas to be incorporated in future law, according to Romania Actualitati editor , Marilena Frâncu.

Reorganization of hospitals and the idea that they no longer be budgetary units were agreed by the majority, and the Secretary of State for Health, Cepoi Vasile explained that if the hospitals will serve as foundations they will not be constrained by several rules, such as staff to be hired or how to additional pay doctors according to workload.

It is known that currently, the activity of a hospital is temporary restricted, he said, precisely because doctors work in private to supplement the income, but hospitals functioning as foundation could enable the doctor to conduct private business here in the hospital.

The Secretary of State Vasile Cepoi reminded that this year there will be a pilot program in which more hospitals will be selected from the academic until the fifth category to discover the benefits, but also the potential problems.

Also, Vasile Cepoi said that in the new law primary health is possible to be integrated into community care and in the evaluation and quality control of health, is necessary to establish an authority to check the quality of all providers in the system.

Asked about the basic package, the president of the Health Insurance House(CAS), Lucian Duta, assured that in terms of emergency medicine all citizens will have access to these services, regardless of the insured or uninsured, but the acceptance basic package there will be a prioritization in the sense that it will provide faster access to those who most need health care, but will create waiting lists.

Private insurer will provide just the opportunity to skip the waiting list.

Some of the changes introduced "before being ready the new normative act"

"It is about reorganization of hospitals, we will establish that structure of evaluation of health services which will allow us to better define the package, and we have proposed, but so far we have to clarify some legal issues, to give the right ,if possible, of this year, public insurance houses to make voluntary insurance "said Vasile Cepoi in an interview for Agerpres.

The Secretary of State Vasile Cepoi explained that on the market of health insurance the society wants a public-private competition system for all the packages of services provided, basic and extra- complementary, and both systems will be developed at the option of the population.

"We completed the first round of consultations with all the partners of dialogue who wanted to participate in them, we identified a number of solutions to major problems that the law proposes to redefine and started to write the most important chapter, the one about health insurance, "said the Secretary of State, Vasile Cepoi.

Vasile Cepoi also says that he wants introduction of competition between public and private system for both basic package of medical services and complementary health care package.

"The basic package is the one since the old law was adopted to which have been made some clarification by reviewing the list of medicines by introducing copayment and with the definition of insured risk, the minor or major risk that you ensure. In discussions until now it seems that it is chosen the option of major risk insurance, "said Vasile Cepoi.
The medical services whose costing do not assume an unsustainable financial effort by the patient will not take the basic package of medical services only for the social protected categories of people.

"To see which are this categories, we will require collaboration of labor ministry, they support this categories. Disorders whose costs exceed the power of financial support will be provided to patients, it is about chronic diseases whose treatment is ongoing and requires constant expense, up to problems whose costs are very high and unbearable for patients. I refer to organ transplant, cancer, rare diseases and others, " also said the Secretary of State.

The old health reform law, withdrawn

Minister of Health, Ladislau Ritli, withdrew in early January, from public debate the bill on the organization and functioning health system in Romania, at the request of Prime Minister Emil Boc.

After about half a month after launching the project in public debate, President Traian Basescu asked the Prime Minister to withdraw the document.

In a press statement made ​​at the Cotroceni Palace, the president said he decided this after finding that public health professionals, and citizens do not want reforming the system.

"Hospitals will not change, family doctors do not want the change, the system of emergency does not want the change of medical system. And of course, I understand by all public signals that most of the does not want the change of public health system. On these conditions I can say that I public demand the Prime Minister to withdraw the project aimed the health reform.

"We talked, in fact, with the Prime Minister the intend to do so, and I do because this was the Presidential Commission, here was proposal for a draft law, here have been professionals who have dedicated to the attempt to make a diagnosis, "said Traian Basescu.

The president reiterated that the project does not require either privatization or abolition of the Service of Mobile Emergency Resuscitation and Extrication, as would be held in public.

Traian Basescu expressed his dissatisfaction in the disinformation in the privatization of hospitals, in the introduction of private health insurance, and financing the private health services from the state budget.

The introduction of the private system "will become a necessity"

Basescu said that during recent years has been a runaway budget of support that state provided to health, and this increase should worry us, because it foresees a consolidated budget deficit problem and therefore introduction of private sector will become a necessity.

"In 2005 Romania's health costs were 10.9 billion lei. In 2011 Romania's health costs were 24.3 billion lei. Increase for health budget was 223 percent. If in 2005 the state budget contribution was 1.9 billion, in 2011 it was 6.2 billion lei ".

"As this is an increasing amount each year is projected in the budget of Romania's two main problems: the deficit of the pension and health system deficit. If we look at growth from year to year of this contribution, things should concern us ", said Basescu.

In this regard, Traian Basescu underlined that the draft law aims to broadening the tax base, promotes additional insurance to bring more sources of income to the state budget.
Traian Basescu said that in current health system corruption work from full, nothing that Romanians are not equal in terms of chances to reach good doctors.

"Not everyone has money to go to a university professor to operate. Many people operate at more or less skilled doctors. From this point of view, corruption is heavy in this system," said Basescu.

The President said that now, "Smart guys are better than ever gluttonize" from existing public funds in health.

Raed Arafat's resignation changed to health draft law

Secretary of State from the Ministry of Health Raed Arafat resigned from the position in early January and said that "coming out from the Ministry of Health will defend better the emergency system."

He said he disagrees with the view of modification of the emergency ministry.
Raed Arafat, said that this change of this control that remained system will disappear.
SMURD chief added that the public emergency was well developed and functioning and that its modification does not guarantee that it will be improved.

Raed Arafat said that there were pressures to privatize part of the emergency medical system and private access to the system was accepted from the beginning.

Raed Arafat said that his views were "not heard"

President Traian Basescu spoke by phone in a show that was invited Secretary of State for Health Raed Arafat and recommended it to submit its observations of the new law in the field to the minister, instead of creating a "public psychosis terms of providing emergency services. "

Raed Arafat claims that health law project, which is in public debate on the website of the Ministry of Health, raises many questions regarding the division of public funds the principles by which they will be distributed, including private care.

Undersecretary of State Raed Arafat said that the Presidential Commission submitted views on the health draft law and that, after a second discussion in committee was not accepted for debate.

Raed Arafat's resignation was followed by street protests in several cities.

After the health draft law was withdrawn, Raed Arafat backtracked to resign as Secretary in the Ministry of Health.

Translated by Ioana Vioreanu
MTTLC, Bucharest University