The health system in Romania has collapsed. Almost all branches of health are paralyzed due to a lack of money: without basic medicines and essential treatments, many hospitals are on the verge of closing, doctors complain about salaries that are far too low, but also about the lack of jobs. The threat of a general strike hangs over all this like a bad dream. Medical professionals are preparing to hang up their coats and take to the streets for higher wages.
At the beginning of this year, due to the debts it was unable to cover and, implicitly, the lack of medicines and sanitary materials, the Emergency County Hospital in Brașov was on the verge of closing. And now, three months after what would have been a premiere in Romania, things have not changed much. Even more dramatic is the fact that other medical units in the country, as well as in Bucharest, are in this borderline situation.
The collapse since then was avoided at the last moment, through bloody negotiations with suppliers. Furthermore, to save money, scheduled surgeries were suspended for three days.
“That, in the event of a major emergency, we have how to intervene and what to work with“, the manager of the health unit, Emil Mailat, explained the decision to us. Although it has passed that moment of crisis, the hospital survives on the edge, from day to day and from week to week. “Since then, not much has changed. Apart from the fact that we have more patients. We are in the same situation, with financial shortfalls and debts to suppliers. Now, for example, we are in negotiations with an infusion provider“, says the manager.
The hospital in Brașov is operating at full capacity, so far no department has been closed, but it is not known what will happen from now on.
“We pay something else, cover another debt, do others and so on. In total, we have 46 million lei in debts to various suppliers, of which 26 have exceeded the 60-day maturity. The biggest shortages are in the area of medicines and sanitary materials”Ovidiu Mailat explains the dramatic situation in which the Brașov hospital is still today.
How much money would be needed for the medical unit that serves one of the largest counties in the country to function optimally? “15-20% per year from the already allocated budget would be enough for us to get out of the impasse”. Specifically, the manager explains, at least one more month of funding from the Health Center would be needed. In the case of this hospital, the amount allocated monthly is 7,800,000 lei.
The winding road of too little money
But the path of the money that covers the medical services offered to patients is difficult and blocked in some places. It goes through the signature of the Ministry of Finance which allocates a certain budget to the National Health Insurance House. From here, the money is distributed to the County Health Centers which, further, allocate it to the hospitals according to the contracts concluded with them.
“This month, the Brașov Health Center managed to increase our ceiling a little. We will settle a little more cases than those that were already contracted. It's an infusion of capital that will help keep us afloat. This month, we received around 9,000,000 lei from the House. That is, 1,200,000 more than the contracted average“, says the director of the Brașov hospital. “We are now waiting for April. Let's see what will happen after we renegotiate the contract with the House”he also confessed to us.
The money is allocated to the medical units taking into account some well-established rules. “The amount is compared to the previous year. For example, what we received last year was related to 2022. But last year, compared to two years ago, we had more cases, more patients, more expenses. Inflation went up, prices went up. But we have to manage with the same budget”.
As for the amounts allocated for investments, they come either from the Ministry of Health or from the local authority. I mean from the town hall.
Approximately 30% of the hospitals in Romania currently have a major budget deficit, it also results from an analysis carried out by the College of Physicians, recently published. This means that hospitals could become insolvent at any moment and close. “We are talking about one out of three hospitals, but the rest are not doing very well either”, warned Daniel Coriu, president of the College of Doctors from Romania. There is only one reason: hospitals receive too little money from CNAS, the respective amounts are not enough to buy medicines, sanitary materials, food for patients, cleaning and hygiene products. What about the huge utility bills.
And, because we are still in the numbers chapter: this year, the Ministry of Finance allocated a budget 29% lower than the requested one to the National Health Insurance House. We are talking, more precisely, about 62.35 billion lei, 30 billion less than what would have been needed. And the consequences could be dramatic.
“We have somewhere around 6% of GDP on health. I would also like 12-14%”recently declared Valeria Herdea, president of CNAS.
The bottom line? “There is a risk that hospitals will close one after the other. We have actually been in that situation when we thought we had no other solution but to put the lock on the door. I can't go by the idea that it will never happen. I have to put the evil first, I can't go on the idea that I won't close. Know that the problem is as real as it gets. If you don't have anything to work with, you don't have a needle, a dressing, a disinfectant, a sedative for patients, you can't do anything”, the hospital manager from Brașov told us.
The problem was also brought to the attention of the President of the College of Doctors from Bucharest, Prof. Dr. Cătălina Poiană. “Fund the hospitals properly! Health costs, but it must be financed!”, she warned.
Low paid guards and unemployed residents
The lack of money from the hospitals' coffers is also found in the pockets of the doctors, many of whom refuse to work as guards. Doctor Mihaela Zaharia, plastic surgeon at the University Hospital in Bucharest and one of the leaders of the Sanitary Solidarity Federation, explained what the situation would be in the future: they are not financially motivated, considering that these guards are paid at the salary of 2018. “This will mean that, if we refuse to do the guard – I am obliged to do a guard, that mandatory guard – this means that if there are seven doctors in a department we do seven guards, the rest of the days remain uncovered”. The doctor is of the opinion that a medical staff who has reached the age of 50 should no longer be on call. “We should only be consulted, do telemedicine for hospitals in the country that do not have specialists, train young doctors, not stay on call at nightZacharias added.
Surgeon Mihaela Zaharia touched on another aspect, namely the situation of resident doctors who find it extremely difficult to find a place in public hospitals in the country. Every year, she said, less than one in ten young people who finish their residency work in public hospitals in the country. The reason? The Romanian state does not open competitive positions for them. “I didn't leave the country, I stayed in state hospitals. We are not resigning, we also encourage young doctors to stay, but know that they have no chance. They do not open competitive positions for doctors who finish their residencies“, said doctor Mihaela Zaharia. According to her, “every year there are 1,500 residents who complete their training, an internship paid by the Romanian state to become specialist doctors, and of these, maybe around 100 end up working in public hospitals in Romania”.
This is also the case of Mirelai Ciobănescu, ATI specialist doctor and the author of a post that became viral on social networks. The young woman recently made some shocking confessions. She complains that after her five years of residency she has not been able to get a job in a state hospital and lives from day to day. “I didn't think that at the age of 30, after six years of college in which I received a scholarship and after five years of residency, with a specialized exam passed with a general average of 9.33, I would still be supported by my parents and I will receive a package from home, because the process of obtaining specialist documents, of obtaining an ATI specialist doctor position will take so long. I thought a lot about whether to write about this. In the end, I did it. The mess should not be hidden under the rug“, the doctor wrote on his Facebook page.
A strike is brewing
The unionists of the “Health Solidarity” Federation are threatening a general strike after a few days ago more than 2,000 medical staff from all over the country protested in Bucharest. The health workers are demanding a salary increase of at least 25% of the gross and say they are getting too little money for the guards. The decision to start the general strike will be taken later this week.
In the event of a general strike, hospitals will operate according to a special schedule. Doctors will be obliged to ensure at least one third of the normal activity of the respective hospital unit. “It is their right to take to the streets as long as the patients are properly cared for. Everything up to the patient. Otherwise, everyone is free to demand their rights and fight for them”also stated Emil Mailat, the manager of the Brașov Emergency Hospital.
