In view of Romania's accession to the European Union, local legislation has to be harmonized with EU requirements. Due to the scarcity of resources, lack of experience and ongoing changes in the political and economic environment, there is still a gap between the legal requisites and the actual implementation status. Unable to support the costs of the numerous centrally controlled healthcare facilities, the government has announced further healthcare reforms, specifically targeting the decentralization of the public healthcare facilities, as well as an increased efficiency and transparency in the allocation of the existing sparse resources.
Decentralization strategy has been defined and approved through a Governmental Decision (i. e. , Decision no. 562/2009 from May 10th, 2009, which entered into force on May 21st, 2009). Furthermore, the Ministry of Health has announced new legislative initiatives aiming to the definition of the basic medical services package to be covered by the mandatory health insurance plan and the introduction of co-payment obligation for public medical services falling outside of such basic package. The envisaged level of co-payments is still under public debate.
So far, the authorities are analysing the benefits of introducing a rather low level of co-payment obligations, in order to educate the patients and prevent unnecessary visits in the ambulatory premises and especially hospital admissions. While the amounts are not very high and do not envisage the poorest and the emergency cases, they have a strong psychological effect due to the public perception that medical care is free of charge. About half of the funds obtained are envisaged to contribute to salaries increase for medical personnel, whose number has been declining given the massive emigration.
Also, the co-payment system is expected to reduce the grey payments of the system. The new legislative framework concerning the two main objectives is expected to be enforced at the end of 2009, following a public campaign of mass education in respect of the co-payment concept and implementation procedures. A clear definition of the basic medical service package, enforcement of current regulation regarding referrals, as well as the deterioration of the public infrastructure, are expected to stimulate the growth of the private medical services sector. Prospects for the private health insurance market in Romania
The legal frame for private health insurance was set in 2004 by the homonymous law, which provides for two types of private health insurance: supplementary and complementary. Up to now, legislation has failed to clearly define the basic package of medical services covered by public insurance. In this context, supplementary or complementary insurance do not represent a real necessity. Due to the absence of clear regulations and to the limited tax deductibility of such services, the private health insurance market remains negligible. In 2008, gross written premiums for private health insurance amounted to EUR 9 mn, which represents a mere 0.5% of the total insurance market.
In the years to come, once specific legislation would be implemented, market makers anticipate that private health insurance is likely to become more sizeable, as informal payments would be gradually phased out and replaced by, inter alia, health insurance premium.
The current regulatory developments regarding the basic medical services covered by mandatory health insurance, the development of the private hospitals infrastructure and the establishment of fair levels of copayment for medical services are supposed to contribute to the long expected increase of the private health insurance services.