Promoting Integrity and Reducing Vulnerabilities to Corruption in the Romanian Health System

Abstract

Some of the priorities of Romania through the National Development Program 2007-2013 regarding health (priorities that overlap with those of the Government Program) are "increasing the accessibility of the population to health services", "improving the quality and safety of the medical act" ", "decision-making transparency in order to increase the efficiency in the use of the allocated resources and in the elimination of damages and corruption acts" and "the legislative and administrative harmonization with the health systems of the states of the European Union ".

In order to achieve these objectives, Transparency International Romania has formulated proposals aimed at promoting integrity, accountability, transparency and reducing the vulnerabilities to corruption in the public health system. By identifying and analysing, it aimed to highlight the risk factors that lead to corruption in the public health sector and to offer recommendations for its reduction.

Findings

1. The health system is incoherently regulated which creates gaps and does not allow the link between health care provider and patient.
2. The budget dedicated to the health sector is insufficient.
3. The hospital, an absolute necessity in any medical system, must be reserved for serious, complicated cases, which can not be resolved in primary care or ambulatory. The hospital is now used excessively to manage cases that do not require admission to hospital.
4. The phenomenon of migration in the medical world has grown in recent years, with residents and young specialists being the most willing to travel to more generous financial areas. According to data published by the Romanian College of Physicians, between 1990 and 2015, 21,000 doctors emigrated, of which 14,100 migrated since 2007.
5. There are no networks or communication systems in place between clinics that enable data sharing on cases between different specialities and levels of care (health fragmentation). 1 out of 4 Romanians will not have a family doctor in the next 5 years, which will lead to the failure of the National Programs of the Ministry of Health and will leave almost 5 million citizens enrolled on family doctors’ lists without primary medical assistance, an unprecedented situation in a member country of the European Union.

Recommendations

1. Improving human resource management in the Health System and updating and adjusting the normative legal framework in this area to comply with European and WHO requirements.
2. Implementing and modernising human resources management by providing a regulatory legal framework on medical personnel and its maintenance, evaluation and continuous development. Develop a framework for appropriate, qualitative and quantitative post-university training for medical staff, according to the needs of the health system, emphasizing the attractiveness of the medical profession.
3. Improve primary health care for under-served population and vulnerable groups. Methods to incentive health care work force in rural and remote areas.
4. Adapting medical and pharmaceutical higher education to reforms in this area and to global requirements, through competency-based training.
5. Devising and establishing robust processes to support the a) introduction and b) implementation of HTA for medicines and vaccines, including developing and finalising a decision-making framework for medicines and vaccines; and HTA Applicant’s Guide.