The authorities want a new evaluation of Romanians' health. Officials recognize that we are a nation of suffering people in a collapsing system, and among the reasons is the near-total lack of prevention. By comparison, in other states of the world, citizens are required to have their tests done periodically. Otherwise, if they get sick, they pay for their own treatment. To what extent we could also adopt these rules and how much they would help us, explained Dr. Mihai Negrea, expert in health policies.
Vaccination is one of the preventive measures that protect us from serious diseases. Photo source: archive
The state of health of Romanians is to be reassessed, announced Valeria Herdea, president of the National Health Insurance Company. The official stated that “there is a state of illness, morbidity, the population is really sick and we have to think about this aspect, that's why we want to do a health assessment. In 2022 we had 4,124,000 holidays, now we have 3,361,000. It is essential to understand that we are approaching morbidity, the disease state we detected in 2019. We are recovering from the pandemic”. The statements came in the context in which Prime Minister Marcel Ciolacu says that Romanians are abusing medical leaves, and in this sense the decision was made to tax these leaves with 10%.
”The right to have access to medical services also means the obligation to go to your family doctor, in such a way that you can help him: this is done in all civilized countries and I think that the Western European model can be also borrowed from us”also stated Valeria Herdea, who says that CNAS will run, starting on March 1, a communication campaign “in such a way that every insured person understands that he has both rights and obligations”.
“I would like the patient to be proactive and come to meet the doctors, to come to the preventive doctor for consultation – this means changing the health behavior”, he also stated the president of CNAS.
Indeed, Romania is chronically ill, experts say. The question is what are we to do? Prevention would be the solution, they say. But even here the powers of the authorities are limited, because it is difficult to copy the successful recipe of other states. In the USA, for example, a lot is invested in screening campaigns. People can have a certain set of free tests every year, and if they don't have these tests and get sick, they pay for the treatment out of their own pocket. In Germany, it's almost the same: if the family doctor considers you to be in a certain risk group and you don't go for tests, in the event of an illness you no longer receive free treatment. You're basically on your own. But what works perfectly for Americans and Germans fails miserably for us. The reason? We are talking about different medical systems, explains epidemiologist Mihai Negrea, specialist in health management at Târgu Mureș. “In America, if you do not respect the screening periods, the insurer increases its insurance premium. Basically, if you get sick, you pay extra. But with us the insurance is fixed. And we have a social medical system. So, we have no way to copy the American recipe that works perfectly for them”he says.
On the other hand, the expert explains, in Romania you don't solve anything with threats like if you don't come to the check-up and you get sick, you pay for your own treatment. “Such a practice cannot stand. It's a slight fantasy. If the heart attack occurs, what do we do? What if a stroke occurs? Complications are usually acute. Many are medical emergencies. And if the man has no money, do you let him die because he didn't get his tests done in time? What do you do with the chronically ill? With those suffering from cancer? Do you stop treating them? Let's be serious! Things are not that simple”says the specialist.
The legislation does not allow us to refer people to the doctor
Moreover, Romanian legislation does not allow us to force a man to go to the doctor. “You cannot impose medical services on a man if he does not want them. It's illegal. This is about patient rights. If a man doesn't want to get vaccinated, you can't force him. If a man refuses certain medical services, and you cannot force him”.
What can we really do to prevent disease? Well-thought-out prevention campaigns. “We had a similar idea around 2008, when diabetes screening was done. And it was a total fiasco.” Dr. Mihai Negrea explained to us. “The mistake was that then the same set of analyzes was done on the whole population. But a target population had to be chosen. It was necessary to go by risk groups, by population segments. For example: obese people over 35 years old. Or if we're talking about a cancer screening… we need to know what cancers it is. Let's do free and mandatory colonoscopies for men over 40… But in reality, everyone wants two, three blood tests that don't say anything… but… we did prevention. I agree with such programs, especially since they have worked very well in other countries. Japan, for example, managed to reduce the incidence of stomach cancers through screenings after 40 years, through colonoscopies and gastroscopies.”
On the other hand, says the expert, doing prevention means “taking the bread from the mouth” of doctors, specialists, laboratories. “The whole health system works on treating diseases. Not on their prevention. We would take the bread out of the mouths of all the specialists in the system if we did prevention. It is not a problem to do prevention. It's simple and cheap. First of all, this must be desired. And this is not only happening here, but all over the world. Everyone would see their jobs threatened. As a specialist, I sit and think: if things happen like this, I have nothing left to work on. This is the reason why, most of the time, the implementation of reforms fails”.
As for the evaluation of the state of health of Romanians proposed by CNAS, Dr. Mihai Negrea believes that it would not be necessary because, he says, we know very well what we are facing. We have data, we have information, we have figures, we have studies. “Let's solve for now the problems we already know, which we are currently facing”.
Why don't Romanians go to the doctor
Obviously, there are many answers: poverty, corruption, bureaucracy, the ignorance of the authorities, the lack of financing of the system and, last but not least, the lack of education of Romanians who only come to the doctor when something hurts. Moreover, prevention, in our country, is almost non-existent. “We don't go to the doctor regularly. But only when we can't anymore, when something hurts. The first time you stay at home, drink tea. After that you stay at home and take some medicine. Then, eventually, when you can't do it anymore, you go to the doctor“, sociologist Gelu Duminică explained for “Adevărul”. Why do we have such a perception? “Historically speaking, the medical service for us was not one of proximity. It was one that man had to make an effort to reach. In the vicinity you had the paramedic or the midwife. Surrogates of the system. The priest was everywhere. The doctor, on the other hand, was 100 kilometers away. With the wagon you traveled for five days, the man died on the way. Then, let's not forget, our hospital appeared quite late. Thank God that a foreigner, Carol Davila, came and made us a health system. We didn't have anything like that. Last but not least, in an area where formal education was very poor, medicine was seen as more of an occult thing. You used to go to the doctor to cheer yourself up.”
Coming back to the present, even though we have a free medical system, it is not actually free in the collective mind. “The informal payments in the system, but also the fact that once we get to the hospital we have to buy our own medicines, makes people “search” only when they have money. Not when you have to. And then they procrastinated endlessly“, explains the specialist.
On the other hand, we also have the culture of self-medication. “We no longer go to the doctor, we administer our own pills. We take antibiotics hard, they solve us for the moment and we see what we do afterwards. We do not think that the body develops immunity. The important thing now is to be well. Man has the pharmacy much closer than the hospital. He stays at the pharmacy for 10 minutes, at the hospital he stays in the hallway for two hours, because no one notices him”.
Dr. Mihai Negrea declared that this mentality is specific to all of Eastern Europe. “It's also a matter of pride not to go to the doctor. You pride yourself on being healthy and you don't need it. But the fact that they feel well, that nothing hurts… this does not mean that those people are necessarily healthy, but that possible diseases are in their early stages. There is also an anecdote that circulates among doctors: there is no such thing as a healthy patient, only insufficiently investigated”said the doctor.
The state of health, says the sociologist Gelu Duminică, is also an effect of the way we act, the way we do things. “Diet, sedentary lifestyle, smoking, alcohol, junk food… All are correlated. The physical education class is done today to a much lesser extent than it was done 30 years ago. Access to unhealthy food is much greater compared to that period. Well, back then we only had syrup, soda and Brifcor”.
There is another aspect: false reporting of illnesses. The sociologist brings up the report of the presidential commission on the analysis of social and demographic risks from 2009. “There are some chapters where they talk about the areas where the number of medical leaves suddenly exploded. I give an example: Şomcuta Mare.. take it like Mirel from Târgu Măgurele, it's random.. and, suddenly, the number of medical leaves increases there by 1,000. Option one: either something happened, an event, that generates a public health problem, and you have to check, or it's fraud and you have to check again. Nothing happens here. And not then we, in fact, do not know the extent of these reports in the system. Nobody knows. Because we don't have an early warning system. What are we doing? We count dooar, we find that's it. I understood Rafila when he said that there is a problem with medical leaves”.
Pharmacist: “The most wanted drugs, those for heart disease”
“Approximately 50% of Romanian patients are chronic patients”, Florina Bonifate, general secretary of the Romanian College of Pharmacists, explained to “Adevărul”. “Cardiovascular diseases are on the first place, if we are to talk about the ailments Romanians suffer from. Therefore, the most requested drugs in pharmacies are for the treatment of heart diseases”, show this. “Then, on the second place in the top of sales of drugs are those that treat seasonal ailments. In the cold period, there are viruses, colds, flu, and then the most released drugs are those that treat the symptoms of these diseases”. However, the specialist declared that in recent years there has been an increase in sales of food supplements that would support the body in the fight against diseases. According to the expert, it seems that Romanians have become more responsible. “This means greater awareness of the need for preventionFlorina Boniface also said.
