Free medical services for the detection of serious diseases. Who are the beneficiaries?

It’s official! All uninsured Romanians will be able to benefit from free medical service packages for the detection of serious ailments. Among them, cancers, chronic hepatitis B and C, but also HIV/AIDS.

Uninsured Romanians will benefit from certain free analyses

The framework contract that will enter into force on July 1 provides, among other things, the introduction of service packages that insured and uninsured people can benefit from, on the main levels of medical assistance, in order to detect serious conditions, namely cancers, chronic hepatitis B and C, and in pregnant women and HIV/AIDS, reports CNAS in a press release.

What will be the responsibility of family doctors

In primary medical care, it is stipulated that family doctors can also refer uninsured people to analyzes and specialist consultations settled by the health insurance company, if they suspect that the patient in question may have an oncological disease.

Family doctors will also be able to issue referral tickets for uninsured people, in order to test them for the hepatitis B and C viruses, as well as for the HIV virus in pregnant women, the respective analyzes also to be settled by the CAS. Given the seriousness of these diseases, it is imperative to detect the cases of infection with the respective viruses as soon as possible, in order to take the necessary medical measures, and the people detected as infected will benefit from access to specific therapies.

Following preventive consultations from the minimum package in primary healthcare, family doctors will issue referral tickets for paraclinical investigations for uninsured people.

The diagnosis, made also following the consultations offered in the mobile caravans

And in the specialized ambulatory medical care, services will be provided to uninsured people for the detection and confirmation of the diagnosis of oncological disease, respectively consultations, diagnostic procedures and medical services for the purpose of case diagnosis. Outpatient specialist doctors will also be able to issue referral tickets for tests and to health units with beds, for day hospitalizations, in order to confirm the oncological condition.

In order to widen the access of patients, both insured and uninsured, to the complex case-diagnosis services in the ambulatory, the condition imposed on providers who perform such services to have both a clinical specialty outpatient clinic and a hospital structure of day in that specialty. Exceptions are made by providers who contract types of services for which this condition is absolutely necessary, such as, for example, case-diagnostic services given to high-risk pregnant women. At the same time, the possibility is created that some medical services for the purpose of case diagnosis can be provided by mobile medical units and medical caravans, in order to allow people from isolated areas access to services for the early detection of oncological conditions, such as breast and cervical cancer .

Service providers will settle the tests prescribed on the referral tickets

Correlated with the novelties of the service packages at the level of primary and specialized care in the clinical outpatient clinic, paraclinical service providers will be able to perform and settle the tests prescribed for uninsured people on the referral tickets issued by family doctors and specialist doctors, and hospital units will be able to settle the day hospitalization services granted to uninsured persons with suspicion of an oncological condition, to confirm the diagnosis.

We remind you that the legislation already provides for the possibility of including uninsured people in the national health programs after confirming the respective diagnosis, these people also being insured without paying the contribution, if they do not generate income.

Since the state of mind of the patient is very important in the progress and success of oncological treatment, in order to make the fight against cancer more efficient, new services related to ambulatory medical care of clinical specialty are introduced, intended for insured persons. These will be specialized psychological services, provided by psychologists with complementary training in psycho-oncology: consultations, counselling, clinical assessment and establishing the psychological intervention plan. Psycho-oncological services can be recommended by doctors specialized or super-specialized in oncological surgery, medical oncology, hematology, pediatric oncology and hematology, radiotherapy, as well as by doctors who provide outpatient palliative care services. Until June 30, 2025, there will be a transition period in which psychological services can still be provided to cancer patients and by psychologists without complementary training in psycho-oncology.

News for cancer patients

Some of the changes concern the implementation of the measures falling under the CNAS in the National Plan to prevent and combat cancer in Romania, approved by Law no. 293/2022, with subsequent amendments and additions. In accordance with this plan, as of July 1 this year, the way of reporting and settlement of services provided to people with suspected oncology, but also to cancer patients, at the level of certain categories of medical service providers under contract with insurance companies will also change. health. The respective providers will keep separate records of the services provided to the mentioned persons, and the financing of these services will also be done separately, through additional documents to the existing contracts. In this way, not only will it be possible to highlight the funds used to detect and fight cancers, but there will also be a much clearer picture of all the services performed for this purpose.

For the oncological diagnostic services provided to uninsured persons, financing will not be made from the contributions paid by the insured, but from the state budget, through the budget of the Ministry of Health, through transfers to FNUASS. In the same way, the testing of uninsured people will be financed in order to detect chronic hepatitis B and C, as well as HIV infection in pregnant women.

At the same time, the current values ​​of the points for primary and specialized outpatient medicine, as well as the reference ceiling for dental medical assistance, will be maintained in the third quarter of the current year.

“We are convinced that the novelties of the Framework Contract will contribute substantially to the detection of serious conditions in their early stages, when the chances of them being treated and the patient continuing his normal life are much higher. These novelties were submitted to public debate in decision-making transparency and were the subject of a series of meetings of the CNAS management with partners in the medical system provided for by Law no. 95/2006, and some provisions were reformulated taking into account the proposals received” – said Valeria Herdea, president of CNAS.