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03.03.2003

Health System's Revival

Romanian people have the smallest life hope expectation from all the Europeans and also the highest rate of infantile and maternal mortality; some of contagious diseases have the specific spreading of underdeveloped countries. At the beginning of each year, the health system is paralyzed till negotiations between decision making and purveyors in the domain come to an end. The greatest drawback of Romanian health system is that nobody knows what may/can expect from it. It is often just a matter of luck to receive compensated medicines, or to have acces to a good doctor or a better equipped surgery. Some of the contributors pay more, some less, and usually the first ones benefit of the public health system less then the second ones.

All of these are not ordinary disfunctionalities, common to any system, but the symptoms of a deep crisis.

The health system in Romania cannot function properly because it is badly conceived. It is an anachronical system, systematically mended, to which the health minister vainly reproaches that is inefficient and wastes enormous funds for modest results. The only responsible for this are the politicians, who do not have the courage to reform the system and make it work. However, the solution of Mrs. Minister Bartos to appoint a colonel in ministry, to "reinforce" the discipline, is a desperate measure which will only increase the rigidity of system and make it more inefficient. This is the symptom of the acute lack of responsibility for what is happening now in the health system: for the money gathered for health that are used in other domains, for the dispelled money and as well as for those money that doctors do not spend it anymore because the financial year reaches the end, for the huge confusion of the contracts signed between medical services purveyors and state on one hand and between state and insurances beneficiaries on the other hand.

Solutions can be only radical and have to start from the principles level; primarily, more pragmatism is needed.

This system has to propose and achive different time level goals, but for doing this, the goals have to be really feasible for all those involved in achieving them. The minimal medical services pack has to be clearly established and also the same should happen with the medical services completely or partially free, of which benefit all the citizens, and for what reasons. At time being, not only that there is no link between the size of contribution and the proper services deserved for this contribution - therefore the market criterion does not work - but even the social criterion, which has to necessarily fine the market one, doesn't work properly, in the context in which the gratuity is only sometimes in accordance with the level of income. The system may become more efficient only if more importance will be given to private medical services purveyors - not just as a luxury segment, but also as private economical agents who administrates better than the state the same funds, even if they are exclusively budgetary, or in co-pay system, or totally private.

The same lack of responsibility from those who manage the health system, but also from Government, can be seen from the way in which the significant funds collected for health are used for unemployment or pensions, and the ones for unemployment - for heating and so on. And all of these happen just because nobody has the courage to retrieve the money owed by the state enterprises or by the "state capitalists" associated to our leaders. Everything is thrown out in a cluster, in a confused numbness, and nobody takes the responsibility of making decisions in our name, the ones paying every month inexisting services. In order to have a functionable health system in Romania - as a country that wants to be a part of EU - contributions collected for health - till the last coin - has to return to the persons that are insured as first-class medical services, justly distributed.

Huge funds collected for health lay down in Treasury because there is not a flexible system of distributing them and because there is the fear that they will be spent in an arbitrary manner. If doctors from different levels and different health compartments surpass their budgets, the solution is not to block the finance source, solution that leads to grotesque situations as those when patients come with medicines or even with fire woods from home or try to get sick in the first days of the month, before doctors finish their budget. The solution for spending money more efficient, which would eliminate the syncopes in financing process, is to stimulate a more efficient management in health, at hospitals level and also at medical offices level. How could they be efficient if they are financed based on the number of treated or hospitalized patients? Doctors from medical offices will tend to have as many patients as possible, doctors from hospitals will hospitalise social cases; thus, quantity is occupying the first place and quality - the medical services - the second. Management quality can be improved not only by competition mechanism, but also by stimulating the managers' performance that will remain in the state/public medical network.

Concrete, pragmatic solutions come out naturally if we establish the general principles that are the basis of health system and that make the system functionable. On the one hand, these principles have to be moral ones. For example, we can`t accept serious, immoral discriminations created by the parallel Health Insurances system from Transports and Police, who benefit not only by employers contributions but also by governmental subventions. On the other hand, these principles have to be pragmatic, because otherwise, indiferent how much money would be gathered for health, they would not be used efficiently. This is the reason why the patient has to have the possibility to choose between the medical services purveyors that lead to a performant management; the possibility of choosing for the patient and also the one of deciding for him has to be based, at first, on the expense he makes in health domain. Between moral principles and pragmatic ones it has to be done a compromise resulted from a large consensus of all performers involved in the medical act, from politicians' level till patient level. This is the only way in which can be stopped the general run away from responsibility that seriously affects the medical system in Romania.