The health reform package brings a series of extremely important changes for both patients and staff and managers in the field. In the following we present briefly the main changes that will affect both state and private units.
The health reform package brings a series of extremely important changes
The Minister of Health, Alexandru Rogobete, has detailed the main aspects of the health reform, which includes over 30 measures and will lead to the efficiency of the system. Of these we list:
– recalculation of the weighted tariffs related to hospitals, including the rates per day of hospitalization, with the introduction of the amount corresponding to the salary influences determined by the salary increases of the medical and non -medical personnel.
“The rate of patients who can be treated in the sanitary unit where they present can be much higher than what we now have on the figures. There are many sanitary units where there is also a surgeon and anesthesiologist, and high -performance and properly equipped operating rooms, and medical and non -medical teams, and medicines and medical supplies and, yet, these patients are transferred to other sanitary units ”.Rogobete explained.
Personal contribution to medical services will be gradually eliminated
– the gradual adjustment, until the elimination of the personal contribution for the medical, hospital services in the private units settled with the National Health Insurance House.
– It is necessary in Romania to develop the private insurances that come complementary to the services that the house settles. Hospitals have not been evaluated and classified for over 20 years. Or demography, the need for medical services has changed, has changed dramatically. For this reason we have many hospitals in Romania who can no longer offer the services that the community in which they are geographically, the community needs them.
Settlement of fictitious services, sanctioned by 10% of the value of the contract
-If a patient is discharged from a private sanitary unit and transferred or re-entry into the same type of care, acute in the case of aggravated or chronic patients for chronic patients, for pathologists of the same type within 48 hours of discharge into a public health unit, “”The transfer of the responsibility of paying the costs related to these services will be transferred to the private sanitary unit that requested the transfer or which determined the patient’s re -entry into the public health”.
– If the control structures of the houses and the Ministry of Health report, according to the contract, in order to settle them, services that have not been performed, and the hospital medical service provider cannot prove them on the basis of their own records, the sanction will be 10% to contravaling the hospitalization services related to the month in which these services were registered.
“In short, the house will not pay 10% of the value of the contract with the health, public or private unit, if such cases of fraud, after all, of the system and fictitious settlement of services are identified.”explained the Minister of Health.
– We will increase the point on the medical service in the specialized clinical ambulatory, from a value of 5 lei as it is today, not actualized for over 10 years, to 6.50 lei from August 1 and to 8 lei from January 1. This will lead to growth, we hope, significant of the number of interventions, diagnosis and treatment, which will be performed in the specialized ambulatory.
– Flexibility of the access of doctors from the hospital sections to the activity in the integrated ambulatory at the level of public hospitals, by adopting an organization model in which all the doctors in the hospital sections, regardless of the didactic title, depending on the daily availability and the dynamics of the clinical activity, can be able to perform an ambulatory consultations without being conditioned by a program.
Fictitious hospitalizations will be sanctioned
– The managers in the state hospitals will be evaluated on the basis of the indicators assumed by the management project, which becomes an annex to the contract and on the basis of other non -negotiated indicators, established by order of the Minister of Health, additional to the indicators that they sign when they sign the management contract with the local authority in the case of the local hospitals, which are in the case of the local authorities.
– We will enter the package with the performance indicators for managers, and evaluation and performance indicators for the department heads, which must take responsibility for the performance of the team they coordinate.
– The fictitious hospitalizations will be sanctioned with the termination of the administration contract of the head of the section and with the termination of the employment contract of the doctor who fictitiously internees a patient in a public hospital.
CNAS chief: The doctor-patient relationship needs a reset
Regarding the changes presented by the president of the National Health House, Horațiu Moldovan, these are:
– The doctor-patient relationship needs a reset. It requires increasing confidence or, better said, I would dare to say, to regain the patient’s confidence in the health system and, at the same time, it is necessary to regain the professional prestige of the doctor.
– One of the general measures refers to the patient’s path through the medical system. Today, the patient often leaves the family doctor’s office in a direction that is not always very clear, does not always know where and to whom it is to be able to benefit from a diagnosis and the most appropriate treatment.
-We will work on an online platform, on a centralized patient programming system in the social health insurance system, so that a patient, if he wants to do a certain investigation, in a certain city, can very easily visualize this and even make an appointment. Of course, we know that many hospitals and clinics have programming systems. We will make them so that they are interoperable to the system we create.
All hospitals, forced to report real costs
– Any patient who receives a medical service, at any level – from family medicine, specialized outpatient, hospital, medical device, pharmacy and so on – will receive a message, an SMS or an e -mail, in which it is informed that the respective service has been performed and, of course, there will be the possibility of transmitting additional information, such as the return for which he has benefited and,
– Starting the following year, all hospitals in Romania, public and private, will be obliged to report the real costs, so that, after the first year of reporting, we will be in the situation where we know exactly how much an appendicitis costs, how much a hernia costs and, thus, we will be able to rethink in the years the financing of hospitals from the perspective of the real costs.
Drug manufacturers will only be paid if the drugs are effective
– In terms of medicines, a new methodology of evaluating medicines and establishing the settlement and repayment of medicines is worked on a new methodology.
The innovative treatments will be replaced with the effective generics at the expiration of the patent, and the producers will be paid for some drugs only as long as the treatment is effective for the patient.
– Authorities want to replace the process by which patients sue the state to receive urgent treatments. In contrast, if there is no other treatment option, the patient can receive the drug directly.
The costs will be partially divided by the company that owns it, and the doctor will be responsible to follow the patient’s condition. In addition, for very high consumption medicines, which exceed 1% of the total drugs sold in Romania, companies will be charged.
– The revenues of family doctors will only decrease, except for family doctors who will have over 4,500 patients. Those who will have over 4,500 patients will have a global decrease of 11%, those who will have below 4,500 patients will have a global increasing increasing of up to 11%, because we practically want an increase in the quality of medical services.
Family doctors, replaced when they are on holidays
– We will also solve the problem of replacing family doctors during the period when they are on rest leave or medical leave, so that its patients can be investigated, consulted by any family doctor to whom they are addressed and, of course, that family doctor will be paid for the services they provide.
– We will prioritize the paraclinical medical investigations, medical analyzes and medical imaging for acute patients, without neglecting oncological patients, in whom the monitor investigations will remain practically unlimited, in the unlimited amount, regardless of the budget allocated to the paraclinical investigations and also for the patients other than the diseases, per year of these conditions.
The result of the investigations must reach the patient in maximum 3 days
– Laboratories that conduct paraclinical investigations such as MRI, CT, scintigraphy and angiography will receive the money from CNAS only if they communicate the results in maximum 3 working days. By the end of 2027, private hospitals will no longer be able to contract new beds-except for the palliation, and in the event that a patient admitted to such a sanitary unit is aggravated and is transferred to the state or re-interned within 48 hours of discharge to a public health unit, the private will pay the medical services, whether or not the patient is insured.
Validity of the extended health card with 10 years
– extension of the duration of the validity of the health card. At the moment, the health card has expired for a good part of the population and we want to extend the validity of the card to 10 years, with the mention that this card will be replaced with the identity card, with the new identity card.
Since the measures are applied
“The first will enter into force from August 1, some of the measures and, of course, by the end of the year, the others. We are talking here of a first ordinance that amends Law 95which we intend to have available until the end of August, and then the secondary normative acts, government decisions, minister orders and so on. So, we believe that, this summer, more than half of the measures discussed will enter into force. But I would make a mention here. In the next two weeks, we will have repeated meetings with unions, patient associations, professional associations and the rest of health institutions, for sure, to reach the final form that can be implemented, because about reforms has been discussed in the last 20 years in Romania, especially in the health system, but they could be applied. For this reason, we try to meet with everyone in the system who apply them, after all, and who meet with them, to give them a shape and a shade, so that they are functional ”the Minister of Health said.
